Metabolic syndrome in severe mental disorders

Effectiveness of Short-Term Lifestyle Modification on Reducing Body- Weight-Related Parameters in Persons with Severe Mental Illness: A Randomized Controlled Trial

Background

Persons with severe mental illness (SMI) reportedly have a high mortality rate due to metabolic syndrome (MS). However, lifestyle modification (LM) offers effective management of some components of MS. This study aimed to evaluate the effectiveness of LM in reducing body-weight-related parameters in SMIs.

Method

Eighty participants with SMI were assigned randomly to either LM (n = 40) or treatment as usual (TAU; n = 40) groups using block randomization (eight blocks of n = 10). The LM group and their caregivers received a structured LM package that included nutrition counselling, recommendations on a balanced diet, and physical activity. The two groups were assessed on body weight, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and quality of life (QOL) at baseline and after three months. Thirty-one LM and 33 TAU participants completed the study.

Results

The LM and TAU groups were comparable on sociodemographic and clinical characteristics and baseline variables of body weight, BMI, WC, and WHR (all P > 0.08). Repeated-measures analysis of variance (RM ANOVA) showed that the LM group had significantly reduced body weight, BMI, WC, and WHR (all P < 0.001) than the TAU group. Similarly, the LM group also showed improvement in their QOL (P < 0.001), whereas TAU showed no improvement.

Conclusions

LM is an effective way to reduce body-weight-related parameters of MS and improves the QOL among persons with SMI in the short term. The caregivers' inclusion during LM contributed to the weight reduction. However, the long-term effect of the intervention could not be assessed.

Oxidative stress parameters and antioxidants in adults with unipolar or bipolar depression versus healthy controls: Systematic review and meta-analysis

BACKGROUND

To study differences in oxidative stress markers and antioxidants among patients with bipolar depression (BPD) and unipolar depression (UPD).

METHODS

Data sources. Electronic MEDLINE/PubMed/Cochrane Library/Scopus/TripDatabase database search until 30/06/2021.

STUDY SELECTION

Included were articles comparing antioxidant or oxidative stress markers between adults with BPD or UPD and healthy controls (HCs).

DATA EXTRACTION

Two authors extracted data independently. Random effects meta-analysis, calculating standardized mean differences for results from ≥3 studies.

RESULTS

Oxidative stress markers reported in 40 studies -1 published repeatedly- (UPD, studies = 30 n = 3072; their HCs, n = 2856; BPD, studies = 11 n = 393; their HCs, n = 540; with 1 study reporting on both UPD and BPD) included thiobarbituric acid reactive substances (TBARS), antioxidant uric acid and antioxidant-enhancing enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione-peroxidase (GPX). Compared with HCs, UPD and BPD were associated with significantly higher levels of TBARS, without differences between UPD and BPD (P = 0.11). Compared with HCs, UPD and BPD did not differ regarding the activity of the CAT (P = 0.28), SOD (P = 0.87) and GPX (P = 0.25) enzymes. However, uric acid levels were significantly higher vs HCs in BPD than in UPD among adult patients (P = 0.004). Results were heterogenous, which, for some parameters, decreased after stratification by the blood source (serum, plasma red blood cells, whole blood).

LIMITATIONS

The main limitations are the small number of studies/participants in the BPD subgroup, and heterogeneity of the results.

SUMMATIONS

Both BPD and UPD may be associated with an impaired oxidative stress balance, with significantly higher uric acid levels vs. HCs in UPD than in BPD.

Berberine, a Herbal Metabolite in the Metabolic Syndrome: The Risk Factors, Course, and Consequences of the Disease

In recent years, the health of patients exposed to the consequences of the metabolic syndrome still requires the search for new solutions, and plant nutraceuticals are currently being intensively investigated. Berberine is a plant alkaloid possessing scientifically determined mechanisms of the prevention of the development of atherosclerosis, type 2 diabetes, and obesity, as well as cardiovascular complications and cancer. It positively contributes to elevated levels of fasting, postprandial blood glucose, and glycosylated hemoglobin, while decreasing insulin resistance. It stimulates glycolysis, improving insulin secretion, and inhibits gluconeogenesis and adipogenesis in the liver; by reducing insulin resistance, berberine also improves ovulation. The anti-obesity action of berberine has been also well-documented. Berberine acts as an anti-sclerotic, lowering the LDL and testosterone levels. The alkaloid exhibits an anti-inflammatory property by stalling the expression of cyclooxygenase 2 (COX-2) and prostaglandin E2. Berberine is neuroprotective and acts as an antidepressive. However, the outcomes in psychiatric patients are nonspecific, as it has been shown that berberine improves metabolic parameters in schizophrenic patients, acting as an adjuvant during antipsychotic treatment. Berberine acts as an anticancer option by inducing apoptosis, the cell cycle arrest, influencing MAPK (mitogen-activated protein kinase), and influencing transcription regulation. The inhibition of carcinogenesis is also combined with lipid metabolism.

Comparison of the Metabolic Characteristics of Newer Second Generation Antipsychotics: Brexpiprazole, Lurasidone, Asenapine, Cariprazine, and Iloperidone With Olanzapine as a Comparator

PURPOSE/BACKGROUND

Extensive research has been conducted comparing the metabolic characteristics of older second-generation antipsychotics (SGAs); minimal data exist comparing the long-term metabolic effects of SGAs approved in the last 10 years.

METHODS/PROCEDURES

A retrospective chart review of patients treated with brexpiprazole, lurasidone, asenapine, cariprazine, and iloperidone (newer SGAs) for at least 6 weeks at an outpatient psychiatric practice was conducted. Patients treated with olanzapine, an older SGA, were included as a comparator. Metabolic characteristics were collected at baseline, approximately 6 weeks, 12 weeks, and for up to 12 months.

FINDINGS/RESULTS

Of the newer SGAs, there were statistically significant increases in patients' average weight at 12 weeks and 1 year or less with brexpiprazole (2.48 lb, P = 0.02; 5.97 lb, P = 0.01) and iloperidone (4.54 lb, P < 0.01; 5.13 lb, P = 0.02). Brexpiprazole and iloperidone resulted in significant increases in body mass index, up to a 0.90-kg/m2 average increase in patients taking brexpiprazole at 1 year or less. Minimal weight gain was seen with cariprazine (4.25 lb, P = 0.42) and asenapine (1.80 lb, P = 0.62) at 1 year or less after treatment initiation. Although not statistically significant, lurasidone showed an average weight loss of up to 0.60 lb at 1 year or less (P = 0.56).

IMPLICATIONS/CONCLUSIONS

Although some weight gain was seen with the newer SGAs, all demonstrated significantly favorable metabolic characteristics compared with olanzapine. Monitoring of weight and metabolic parameters remain important in patients treated with SGAs.

Determinants of Physical Health Self-Management Behaviours in Adults With Serious Mental Illness: A Systematic Review

Behavioural interventions can support the adoption of healthier lifestyles and improve physical health outcomes, but it is unclear what factors might drive success of such interventions in people with serious mental illness (SMI). We systematically identified and reviewed evidence of the association between determinants of physical health self-management behaviours in adults with SMI. Data about American Association of Diabetes Educator's Self-Care Behaviours (AADE-7) were mapped against the novel Mechanisms of Action (MoA) framework. Twenty-eight studies were included in the review, reporting evidence on 104 determinant-behaviour links. Beliefs about capabilities and beliefs about consequences were the most important determinants of behaviour, especially for being physically active and healthy eating. There was some evidence that emotion and environmental context and resources played a role in determining reducing risks, being active, and taking medications. We found very limited evidence associated with problem solving, and no study assessed links between MoAs and healthy coping. Although the review predominantly identified evidence about associations from cross-sectional studies that lacked validated and objective measures of self-management behaviours, these findings can facilitate the identification of behaviour change techniques with hypothesised links to determinants to support self-management in people with SMI. Systematic Review Registration: PROSPERO, registration CRD42018099553.

The Relationship between Community Participation and Physical Activity among Individuals with Serious Mental Illnesses

INTRODUCTION

The importance of physical activity (PA) and health outcomes for individuals with serious mental illnesses (SMI) has been well documented. It is also established that individuals with SMI engage in high amounts of sedentary behavior and low amounts of physical activity, which contributes to poor health outcomes. This study explores the relationship between community participation, physical activity, and sedentary behavior among individuals with SMI.

METHODS

This study used a sample of individuals with SMI who were receiving community mental health services in a large urban area of the United States. Of the 526 individuals approached, 308 were interested in the study; 173 consented and completed data collection. This study reports on 152 participants who had complete data. Using the Temple University Community Participation Scale, participants reported on community-based activities completed independently in the previous 30 days. Additionally, participants were asked to wear a tri-axial accelerometer (ActiGraph GT3X) on the non-dominant wrist for seven days. The total number of community participation days was correlated with PA variables including steps, sedentary, light, and moderate-vigorous PA. Two groups of step data were analyzed using t-tests: ≥7500 steps, and ≥ 10,000 steps. Logistic regressions were run to examine the relationship between amount, breadth and sufficiency of community participation and having +/- 7,500 steps and +/- 10,000 daily steps, controlling for age, gender, and income.

RESULTS

Amount of community participation was inversely associated with the % of time in sedentary activity and positively associated with the % of time in moderate to vigorous PA. Those with at or more than 7500 steps and 10,000 steps reported significantly more days of community participation.

CONCLUSION

This study highlights the contribution of everyday activities for increased physical activity and reduced time spent in sedentary activity. Practitioners should consider recommendations for engagement in the community to increase opportunities for walking.

The effects of acceptance and commitment therapy on lifestyle and behavioral changes: A systematic review of randomized controlled trials

PURPOSE

To determine, evaluate, and synthesize the best available evidence about the evidence-based pragmatic effects of acceptance and commitment therapy (ACT) on lifestyle and behavioral changes (LBCs).

DESIGN AND METHODS

The PICOS formulations were used to improve the search strategy of this systematic review with the aim to find the right evidence and ask the right questions. The assessed articles were subjected to quality assessment using the PRISMA checklist and the Joanna Briggs Institute's standardized critical assessment and data extraction tools.

FINDINGS

This study involved 30 randomized controlled trials (RCTs) which met the research criteria. Although the included RCTs have several limitations in themselves, the results of this study suggested that the ACT will help maintain long-term LBCs (eg, weight management, effective coping with substance-related and addictive problems, eating and physical activity).

PRACTICE IMPLICATIONS

Given that ACT is a trandiagnostic approach that promotes health-related LBCs in many diseases and populations, it seems reasonable for clinicians to use and test ACT to achieve pragmatic results.

Adipokine levels are associated with insulin resistance in antipsychotics users independently of BMI

BACKGROUND

The prevalence of obesity, metabolic syndrome and type 2 diabetes mellitus is increased among patients with severe mental disorders, and particularly use of second generation antipsychotic drugs is associated with metabolic side effects. Antipsychotics have been found to alter levels of adipokines which regulate insulin sensitivity, but their role in antipsychotic-associated insulin resistance is not established, and it is unclear whether adipokines affect insulin resistance independently of body mass index (BMI).

METHODS

We included 1050 patients with severe mental disorders and 112 healthy controls aged 18-65 years from the Oslo area, Norway. Clinical variables, BMI and use of medication were assessed, fasting blood samples were obtained for calculation of the leptin/adiponectin ratio (L/A ratio) and estimate of insulin resistance using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Case-control analyses were followed by mediation analyses to evaluate the possible direct effect of antipsychotics on HOMA-IR and indirect effect mediated via the L/A ratio. This was performed both with and without adjustment for BMI, in the total sample and in an antipsychotic monotherapy subsample (N = 387).

RESULTS

BMI, L/A ratio and HOMA-IR were significantly higher in patients than controls (p < 0.001-p = 0.01). There was a significant direct effect from use of antipsychotics in general on HOMA-IR both without (b = 0.03, p = 0.007) and with adjustment for BMI (b = 0.03, p = 0.013), as well as a significant mediating effect via L/A ratio both without (b = 0.03, p < 0.001) and with adjustment for BMI (b = 0.01, p = 0.041). Use of olanzapine (b = 0.03, p < 0.001) or aripiprazole (b = 0.04, p < 0.001) in monotherapy showed significant effects on HOMA-IR mediated via L/A ratio.

CONCLUSIONS

The study suggests that use of antipsychotics may alter adipokine levels, and that increased L/A ratio may play a role in the development of insulin resistance associated with use of antipsychotics also independently of BMI.

Streptozotocin causes acute responses on hippocampal S100B and BDNF proteins linked to glucose metabolism alterations

Streptozotocin (STZ) is a glucosamine-nitrosourea commonly used to induce long-lasting models of diabetes mellitus and Alzheimer's disease. Direct toxicity of STZ on the pancreas and kidneys has been well characterized, but the acute effect of this compound on brain tissue has received less attention. Herein, we investigated the acute and direct toxicity of STZ on fresh hippocampal slices, measuring changes in BDNF and S100B secretion (two widely-used peripheral markers of brain injury), as well as glucose metabolism. Moreover, we investigated in vivo changes of these proteins in the hippocampus, 48 h after intracerebroventricular STZ administration. Transverse hippocampal slices (0.3 mm thick) were obtained using a McIlwain tissue chopper and target proteins were measured in the incubation medium by ELISA. STZ decreased S100B secretion, but increased BDNF secretion as well as causing impairment in glucose uptake in hippocampal slices, measured using [³H] deoxy-glucose. Glucose levels and glucose metabolism differentially modulated S100B secretion in astrocytes and BDNF secretion in neurons, when evaluated under specific conditions (high-potassium medium, presence of tetrodotoxin or fluorocitrate). Moreover, at 48 h after intracerebroventricular STZ, hippocampal BDNF content, but not S100B, was reduced. Our results indicate that BDNF and S100B are useful and sensitive markers of glucose metabolism disturbance and reinforce these proteins as general acute markers of brain disorders.

The association between low-grade inflammation and the clinical features of bipolar disorder in Han Chinese population

Variety of evidence suggests that low-grade inflammation may be involved in the pathophysiology of bipolar disorder (BD). However, the conclusion regarding the relationship between inflammation and BD has been inconsistent. In this study, we aimed to survey the prevalence of low-grade inflammation in a large Han Chinese population with BD and assess its impact on the clinical features of BD. 430 eligible cases were drawn from patients who were admitted or had ever been admitted for BD to the inpatient service of the psychiatric department of the Third Hospital of Sun Yat-sen University. Subjects with current active physical diseases or white blood count (WBC) >19.0 × 10⁹/L (2 times the upper reference) were excluded. Serum C-reactive protein (CRP) levels and WBC were measured with fast blood sample. Low-grade inflammation was defined as CRP>3 mg/L or WBC > 9.5 × 10⁹/L(the upper reference). Clinical features of BD were collected through semi-structural interview conducted by trained interviewers with background of psychiatric education. If defined as CRP>3 mg/L, the prevalence of low-grade inflammation among BD was 10.1% (41/404), it was positively associated with BMI (p = 0.012), comorbidity of glycolipid metabolic diseases(p = 0.018). After adjusting for BMI, it was found to be positively related to recent suicide attempt (p = 0.03), initiation with (hypo)manic episode(p = 0.047), leaden paralysis (p = 0.037) and family history of mental disorders(p = 0.012), while the association between comorbidity of glycolipid metabolic diseases and low-grade inflammation disappeared (p = 0.330). If defined as WBC > 9.5 × 10⁹/L, the prevalence of low-grade inflammation was 8.1% (33/409), it was positively associated with psychotic features (p = 0.011) and adverse life events before the onset of illness(p < 0.001), but was not significantly influenced by BMI (p = 0.077). A much lower prevalence of low-grade inflammation in BD is found among Han Chinese population than among western population. Low-grade inflammation of different definition impacts differentially on the clinical features of BD.

Impact of lifestyle modification on some components of metabolic syndrome in persons with severe mental disorders: A meta-analysis

BACKGROUND

Metabolic syndrome (MS) is reportedly associated with high mortality from mostly cardiovascular causes in patients with severe mental disorders (SMD). Lifestyle interventions augment effective management of MS in patients with SMD. The present meta-analysis aims at updating the recent evidence on the effectiveness of lifestyle intervention for MS in patients with SMD.

METHOD

A literature search for English Language publications of randomized controlled trials (RCTs) from 2001 to 2016 comparing lifestyle modification (LM) with treatment as usual (TAU) in the management of MS were identified. Using PRISMA guidelines, 19 RCTs reporting data on 1688 SMD and MS patients and providing data on change in Body Weight, Body Mass Index (BMI) and waist circumference (WC) were included. Using random effects model, standardized mean difference between LM and TAU for the mean baseline-to-endpoint change in body weight, BMI and WC was calculated with a 95% confidence limit, on RevMan 5.3. The study was registered with PROSPERO (CRD42016046847).

RESULTS

LM had significantly superior efficacy in the reducing weight (-0.64, 95% CI -0.89, -0.39, Z = 5.03, overall effect p < 0.00001), BMI (-0.68, 95% CI -1.01, -0.35, Z = 4.05, overall effect p < 0.0001), and WC (-0.60, 95% CI -1.17, -0.03, Z = 2.06; overall effect p = 0.04), compared to TAU. LM was significantly more effective than TAU even in short duration (p = 0.0001) and irrespective of the treatment setting.

CONCLUSION

Interventions targeting LM in persons with SMD and MS are effective in reducing body weight, BMI and WC. It must be routinely recommended to all patients with SMD, ideally during commencement stage of second generation antipsychotic treatment.

Clinical Scenario of the Metabolic Syndrome

The term metabolic syndrome (MeS) refers to a cluster of associated symptoms composed of impaired fasting glucose, abdominal obesity, hypertension, and dyslipidemia. MeS is associated with an increased risk of cardiovascular and diabetes-associated morbidity and mortality. The increased amount of visceral fat together with a chronic inflammatory state predisposes to the development of arteriosclerosis. Furthermore, insulin resistance (IR) and dyslipidemia are associated with fatty liver disease. In addition, MeS is linked to non-cardiovascular diseases such as cancer as well as psychiatric or endocrine disorders. Here, we discuss the clinical impact of MeS in cardiovascular and non-cardiovascular diseases to highlight the importance of prevention, early diagnosis, and multifactorial treatment of high-risk individuals.

[Cardiovascular risk factors in users with severe mental disorder]

OBJECTIVE

To identify the prevalence of the cardiovascular risk (RCV) in users with a Severe Mental Disorder (SMD) attended in mental health service in ParcTaulí (Sabadell - Barcelona).

METHOD

This is an observational, descriptive and transversal study of the factors of cardiovascular risk in 789 users with SMD. The instrument used was the scale of assessment of the Registre Gironí del Cor, which estimates the risk of cardiovascular disease.

RESULTS

26.6% of the sample has RCV (22.5% moderate, 3.8% high and 0.3% very high). The analysis of the modifiable risk factors shows that 16.5% of the patients are hypertensive, 55.2% are smokers, 19.77% have hyperglycaemia (8.2% of whom are diagnosed of diabetes mellitus), 40.2% have obesity, 36.2% overweight and 47.27% hypercholesterolemia.

CONCLUSIONS

The study confirms that the prevalence of the RVC in SMD users is greater than the RCV in general population and it's associated to the presence of modifiable risk factors. Health education carried out by nurses is the best to prevent the RCV in SMD users.

Circadian Clocks as Modulators of Metabolic Comorbidity in Psychiatric Disorders

Psychiatric disorders such as schizophrenia, bipolar disorder, and major depressive disorder are often accompanied by metabolic dysfunction symptoms, including obesity and diabetes. Since the circadian system controls important brain systems that regulate affective, cognitive, and metabolic functions, and neuropsychiatric and metabolic diseases are often correlated with disturbances of circadian rhythms, we hypothesize that dysregulation of circadian clocks plays a central role in metabolic comorbidity in psychiatric disorders. In this review paper, we highlight the role of circadian clocks in glucocorticoid, dopamine, and orexin/melanin-concentrating hormone systems and describe how a dysfunction of these clocks may contribute to the simultaneous development of psychiatric and metabolic symptoms.

Second-generation antipsychotics and adiponectin levels in schizophrenia: A comparative meta-analysis

People with schizophrenia treated with second-generation antipsychotics (SGAs) have lower plasma adiponectin levels, as compared with general population, that may lead to metabolic abnormalities. However, the contribution of different SGAs on adiponectin dysregulation is still unclear. The objective of this systematic review and meta-analysis was to estimate differences in adiponectin levels among people with schizophrenia treated with different SGAs. We systematically searched for observational studies published up to March 2015 in main electronic databases. Different SGAs were included if data on adiponectin were available from at least three different samples involving as a minimum five participants per treatment arm. Standardized mean differences with relevant 95% confidence intervals were generated. I(2) was used to test heterogeneity among studies. Eight studies were included with data suitable for carrying out four different comparisons: Clozapine vs. Olanzapine (including n=877 individuals with schizophrenia); Clozapine vs. Risperidone (n=660); Olanzapine vs. Risperidone (n=738); Quetiapine vs. Risperidone (n=186). There were no differences on adiponectin levels between people taking Clozapine and those taking Olanzapine (p=0.86), but high heterogeneity was detected (I(2)=82%). Both individuals taking Clozapine (p<0.001; I(2)=0%) and those taking Olanzapine (p=0.02; I(2)=9%), but not subjects treated with Quetiapine (p=0.47; I(2)=0%), had adiponectin levels significantly lower than people taking Risperidone. Our findings are consistent with previous evidence showing greater metabolic abnormalities attributable to Clozapine and Olanzapine, as compared with other SGAs. Although mechanisms whereby both these SGAs influence adiponectin remain unexplained, its reduction might mediate relevant abnormalities. Prospective evaluations of long-term effects of different SGAs on adiponectin are needed.

Predictors of Nurse Support for the Introduction of the Cardiometabolic Health Nurse in the Australian Mental Health Sector

PURPOSE

A cardiometabolic specialist nursing role could potentially improve physical health of people with serious mental illness.

DESIGN AND METHODS

A national survey of Australian nurses working in mental health settings investigated predictors of support for the role.

FINDINGS

Predictors included belief in physical healthcare neglect, interest in training; higher perceived value of improving physical health care.

PRACTICE IMPLICATIONS

The findings suggest that nurses see the cardiometabolic health nurse role as a promising initiative for closing gaps in cardiometabolic health care and skilling other nurses in mental health. However, as the majority of variance in cardiometabolic health nurse support was unexplained, more research is urgently needed on factors that explain differences in cardiometabolic health nurse endorsement.

Administering intramuscular injections: how does research translate into practice over time in the mental health setting?

BACKGROUND

Increasingly, mental health nurses are expected to base their clinical practice on evidence based knowledge and many of the practice traditions that have passed between generations of nurses must now be examined within this scientific context. Since 2000, there has been an increasing debate on what is best practice for the administration of intramuscular injections particularly in relation to site selection, needle size and technique. Weight gain associated with second generation long acting antipsychotics influences the site and needle size for effective medication delivery.

AIM

To determine intramuscular injecting practice choices made by nurses working in the mental health setting in 2006 compared to those made by a similar group of nurses in 2012.

METHODS

A descriptive cross sectional study conducted across two time points: 2006 (93 participants) and 2012 (245 participants) utilising the same questionnaire designed to measure nurses' intramuscular injecting practice choices.

RESULTS

Data were analysed using SPSS version 20 package. Six statistically significant practice changes were recorded related to needle size, site selection and the use of the Z-tracking technique. A continued higher usage of the dorsogluteal site was also reported in 2012 contrary to the recommendations in the current research for the ventrogluteal site.

CONCLUSION

Whilst some practice changes occurred, translation of research into evidenced based practice is challenging and definitive best practice in the administration of intramuscular injections remains unclear. Education and randomised controlled trials are needed to provide the evidence to ensure the delivery of safe and effective intramuscular injecting practice.

Effects of oxidative stress on fatty acid- and one-carbon-metabolism in psychiatric and cardiovascular disease comorbidity

OBJECTIVE

Cardiovascular disease (CVD) is the leading cause of death in severe psychiatric disorders (depression, schizophrenia). Here, we provide evidence of how the effects of oxidative stress on fatty acid (FA) and one-carbon (1-C) cycle metabolism, which may initially represent adaptive responses, might underlie comorbidity between CVD and psychiatric disorders.

METHOD

We conducted a literature search and integrated data in a narrative review.

RESULTS

Oxidative stress, mainly generated in mitochondria, is implicated in both psychiatric and cardiovascular pathophysiology. Oxidative stress affects the intrinsically linked FA and 1-C cycle metabolism: FAs decrease in chain length and unsaturation (particularly omega-3 polyunsaturated FAs), and lipid peroxidation products increase; the 1-C cycle shifts from the methylation to transsulfuration pathway (lower folate and higher homocysteine and antioxidant glutathione). Interestingly, corresponding alterations were reported in psychiatric disorders and CVD. Potential mechanisms through which FA and 1-C cycle metabolism may be involved in brain (neurocognition, mood regulation) and cardiovascular system functioning (inflammation, thrombosis) include membrane peroxidizability and fluidity, eicosanoid synthesis, neuroprotection and epigenetics.

CONCLUSION

While oxidative-stress-induced alterations in FA and 1-C metabolism may initially enhance oxidative stress resistance, persisting chronically, they may cause damage possibly underlying (co-occurrence of) psychiatric disorders and CVD. This might have implications for research into diagnosis and (preventive) treatment of (CVD in) psychiatric patients.

Interactions between diabetes and anxiety and depression: implications for treatment

Anxiety or depression may be a risk factor for the development of diabetes. This relationship may occur through a combination of genetic predispositions; epigenetic contingencies; exacerbating conditions such as metabolic syndrome (a precursor to diabetes); and other serious medical conditions. Medications used to treat anxiety and depression have significant side effects, such as weight gain, further increasing the possibility of developing diabetes. These components combine, interact, and reassemble to create a precarious system for persons with, or predisposed to, diabetes. Clinicians must be aware of these interrelationships to adequately treat the disease.

Autoantibodies and the immune hypothesis in psychotic brain diseases: challenges and perspectives

The pathophysiology of psychosis is poorly understood, with both the cognitive and cellular changes of the disease process remaining mysterious. There is a growing body of evidence that points to dysfunction of the immune system in a subgroup of patients with psychosis. Recently, autoantibodies directed against neuronal cell surface targets have been identified in a range of syndromes that feature psychosis. Of interest is the detection of autoantibodies in patients whose presentations are purely psychiatric, such as those suffering from schizophrenia. Autoantibodies have been identified in a minority of patients, suggesting that antibody-associated mechanisms of psychiatric disease likely only account for a subgroup of cases. Recent work has been based on the application of cell-based assays-a paradigm whose strength lies in the expression of putative antigens in their natural conformation on the surface of live cells. The responsiveness of some of these newly described clinical syndromes to immune therapy supports the hypothesis that antibody-associated mechanisms play a role in the pathogenesis of psychotic disease. However, further investigation is required to establish the scope and significance of antibody pathology in psychosis. The identification of a subgroup of patients with antibody-mediated disease would promise more effective approaches to the treatment of these high-morbidity conditions.

Risk of developing diabetes mellitus and hyperlipidemia among patients with bipolar disorder, major depressive disorder, and schizophrenia: a 10-year nationwide population-based prospective cohort study

BACKGROUND

The high comorbidity of metabolic side effects with severe mental disorders (SMDs), including bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia, had gained much attention, because the excess mortality of these patients is mainly due to physical illness. However, most of these studies were with cross-sectional study design, the time course of metabolic side effects and SMD cannot be elucidated without a cohort study.

METHOD

Using a nationwide database with a large sample size and a matched control cohort study design, we enrolled patients with SMDs but without diagnoses of and medications for DM and hyperlipidemia from 1996 to 2000, and followed them to the end of 2010. We compared them with age and gender-matched controls (1:4) for the incidence of DM and hyperlipidemia.

RESULTS

The identified cases were 367 patients with BD, 417 patients with MDD, and 1993 patients with schizophrenia, with average age of 45.3 ± 14.0, 46.5 ± 13.7, and 45.9 ± 12.3, respectively. The patients with BD and schizophrenia had increased risk of initiation of anti-diabetic medications (10.1% vs. 6.3%, p=0.012; 13.3% vs. 7.2% p<0.001; respectively), and anti-hyperlipidemia medications (15.8% vs.10.5%, p=0.004; 14.2% vs.12.1%, p=0.005; respectively) than the controls. After controlling age, gender, urbanization, and income, the Cox regression model showed significantly increased risk of initiation of anti-diabetic medications among patients with BD (hazard ratio (HR) of 1.702, 95% confidence interval (CI): 1.155-2.507) and schizophrenia (HR of1.793, 95% CI: 1.532-2.098). Increased risk of initiation of anti-hyperlipidemia medications was also noted among patients with BD (HR of 1.506, 95% CI: 1.107-2.047) and schizophrenia (HR of 1.154, 95% CI: 1.002-1.329). The patients with MDD did not show increased risk of initiation of these medications than the controls.

CONCLUSIONS

This first 10-year nationwide population-based prospective matched control cohort study showed increased risks of initiation of anti-diabetic and anti-hyperlipidemia medications among patients with BD and schizophrenia. No significant increased risk was noted among the patients with MDD.

Physical health of patients with bipolar disorder

OBJECTIVE

This article reviews the characteristics of bipolar disorder and approaches to minimise physical health risks, as well as treatment options, and their influence on patient quality of life (QoL).

METHOD

The content of this article is based on the proceedings of a 1-day standalone symposium in November 2011 exploring how to establish a bipolar clinic within the context of existing services in the UK's National Health Service.

RESULTS

Bipolar disorder is a common mental disorder and often under-recognised in patients with major depressive episodes. Patients are largely dependent on family and carers to lead normal lifestyles and have difficulties maintaining relationships. Mental health and physical health are closely linked, with risk factors such as weight gain, metabolic syndrome, smoking and diabetes contributing to cardiovascular disease and early death. Antipsychotics may induce treatment-related comorbidities, thus further contributing to a low QoL of patients. Symptoms of comorbidity or depression are frequently relieved through self-medication and substance abuse, thus increasing patient health and suicide risk. Therefore, regular health monitoring and patient education in risk factor minimisation are required.

CONCLUSION

Early pharmacotherapeutic and psychoeducational interventions are required to improve treatment outcomes, as well as improving patient understanding of ways to minimise comorbidity development.

Can bipolar disorder be viewed as a multi-system inflammatory disease?

BACKGROUND

Patients with bipolar disorder are known to be at high risk of premature death. Comorbid cardio-vascular diseases are a leading cause of excess mortality, well above the risk associated with suicide. In this review, we explore comorbid medical disorders, highlighting evidence that bipolar disorder can be effectively conceptualized as a multi-systemic inflammatory disease.

METHODS

We conducted a systematic PubMed search of all English-language articles recently published with bipolar disorder cross-referenced with the following terms: mortality and morbidity, cardio-vascular, diabetes, obesity, metabolic syndrome, inflammation, auto-antibody, retro-virus, stress, sleep and circadian rhythm.

RESULTS

Evidence gathered so far suggests that the multi-system involvement is present from the early stages, and therefore requires proactive screening and diagnostic procedures, as well as comprehensive treatment to reduce progression and premature mortality. Exploring the biological pathways that could account for the observed link show that dysregulated inflammatory background could be a common factor underlying cardio-vascular and bipolar disorders. Viewing bipolar disorder as a multi-system disorder should help us to re-conceptualize disorders of the mind as "disorders of the brain and the body".

LIMITATIONS

The current literature substantially lacks longitudinal and mechanistic studies, as well as comparison studies to explore the magnitude of the medical burden in bipolar disorder compared to major mood disorders as well as psychotic disorders. It is also necessary to look for subgroups of bipolar disorder based on their rates of comorbid disorders.

CONCLUSIONS

Comorbid medical illnesses in bipolar disorder might be viewed not only as the consequence of health behaviors and of psychotropic medications, but rather as an early manifestation of a multi-systemic disorder. Medical monitoring is thus a critical component of case assessment. Exploring common biological pathways of inflammation should help biomarkers discovery, ultimately leading to innovative diagnostic tools, new methods of prevention and personalized treatments.

Mental disorders in patients with metabolic syndrome. The key role of central obesity

BACKGROUND

The Authors sought to evaluate current prevalence of mental disorders in patients affected by metabolic syndrome compared with patients affected by central obesity alone.

METHODS

186 (63.5%) patients affected by central obesity and 107 (36.5%) affected by metabolic syndrome according to ICF criteria were interviewed by means of SCID I.

RESULTS

Axis I current prevalence was respectively 45.7% and 44.9% among patients with central obesity and patients with metabolic syndrome, differences which were not significant. No statistically significant differences were found between groups as far as each single axis I diagnostic category was concerned. Moreover, current prevalence of any axis I, anxiety and mood disorders were independent of the number of components of metabolic syndrome.

CONCLUSION

metabolic syndrome is associated to an higher risk for current mental disorders, which seems to be mainly due to the strong association of central obesity to psychopathology.