Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Mar;20(1):63-73.
doi: 10.31887/DCNS.2018.20.1/bpenninx.

Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications

Brenda W J H Penninx  1 , Sjors M M Lange  1
Affiliations
Review

Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications

Brenda W J H Penninx et al. Dialogues Clin Neurosci. 2018 Mar.

Abstract
in English, Spanish, French

Psychiatric patients have a greater risk of premature mortality, predominantly due to cardiovascular diseases (CVDs). Convincing evidence shows that psychiatric conditions are characterized by an increased risk of metabolic syndrome (MetS), a clustering of cardiovascular risk factors including dyslipidemia, abdominal obesity, hypertension, and hyperglycemia. This increased risk is present for a range of psychiatric conditions, including major depressive disorder (MDD), bipolar disorder (BD), schizophrenia, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and posttraumatic stress disorder (PTSD). There is some evidence for a dose-response association with the severity and duration of symptoms and for a bidirectional longitudinal impact between psychiatric disorders and MetS. Associations generally seem stronger with abdominal obesity and dyslipidemia dysregulations than with hypertension. Contributing mechanisms are an unhealthy lifestyle and a poor adherence to medical regimen, which are prevalent among psychiatric patients. Specific psychotropic medications have also shown a profound impact in increasing MetS dysregulations. Finally, pleiotropy in genetic vulnerability and pathophysiological mechanisms, such as those leading to the increased central and peripheral activation of immunometabolic or endocrine systems, plays a role in both MetS and psychiatric disorder development. The excess risk of MetS and its unfavorable somatic health consequences justifies a high priority for future research, prevention, close monitoring, and treatment to reduce MetS in the vulnerable psychiatric patient.

Los pacientes psiquiátricos tienen un mayor riesgo de mortalidad prematura, principalmente por enfermedades cardiovasculares (ECVs). Existe evidencia convincente que muestra que las condiciones psiquiátricas están caracterizadas por un aumento del riesgo del síndrome metabólico (SMet), un conjunto de factores de riesgo cardiovascular que incluyen dislipidemia, obesidad abdominal, hipertensión e hiperglicemia. Este riesgo aumentado se presenta en diversas condiciones psiquiátricas como trastorno depresivo mayor (TDM), trastorno bipolar (TB), esquizofrenia, trastorno de ansiedad, trastorno por déficit de atención con hiperactividad (TDAH) y trastorno por estrés postraumático (TEPT). Al parecer existe alguna evidencia de una asociación dosis-respuesta entre la gravedad y duración de los síntomas y el impacto longitudinal bidireccional entre los trastornos psiquiátricos y el SMet. En general las asociaciones parecen más potentes con la obesidad abdominal y la dislipidemia que con la hipertensión. Los mecanismos que contribuyen a esto son un estilo de vida poco saludable y una pobre adherencia al tratamiento médico, condiciones que son prevalentes entre los pacientes psiquiátricos. Los medicamentos psicotrópicos específicos también han demostrado un impacto importante en el aumento de las fallas en la regulación del SMet. Por último, la pleiotropía en la vulnerabilidad genética y los mecanismos fisiopatológicos, como los que conducen a una mayor activación central y periférica de los sistemas inmunometabólico y endocrino, tienen un papel tanto en el desarrollo del SMet como del trastorno psiquiátrico. El riesgo aumentado del SMet y las consecuencias desfavorables en la salud somática justifican una prioridad alta para la investigación, prevención, monitorización estricta y tratamiento para reducir a futuro el SMet en el paciente psiquiátrico vulnerable.

Les patients psychiatriques ont un risque plus élevé de mortalité prématurée, surtout en raison des maladies cardiovasculaires (MCV). D'après des données convaincantes, les troubles psychiatriques se caractérisent par un risque augmenté de syndrome métabolique (SM), un ensemble de facteurs de risque cardiovasculaire comprenant une dyslipidémie, une obésité abdominale, une hypertension et une hyperglycémie. Dans ces troubles psychiatriques, on trouve le trouble dépressif caractérisé (TDC), le trouble bipolaire (TB), la schizophrénie, le trouble anxieux, le trouble déficit de l'attention/hyperactivité (TDAH) et le trouble de stress post-traumatique (TSPT). Il semble exister une association dose-réponse entre la sévérité et la durée des symptômes et l'impact longitudinal bidirectionnel entre les troubles psychiatriques et le SM. Ces associations paraissent généralement plus fortes avec l'obésité abdominale et les dyslipidémies qu'avec l'hypertension. Un mode de vie malsain et une mauvaise adhésion au traitement médical, fréquents chez les patients psychiatriques, y participent. Les traitements psychotropes spécifiques influent fortement sur l'augmentation des dysrégulations du SM. Enfin, la pléiotropie de la vulnérabilité génétique et des mécanismes physiopathologiques, comme de ceux qui augmentent l'activation centrale et périphérique des systèmes endocriniens ou immunométaboliques, joue un rôle dans le développement à la fois du SM et des troubles psychiatriques. Ce risque majoré de SM et ses conséquences négatives sur la santé somatique justifient une priorité élevée pour la recherche, la prévention, la surveillance étroite et le traitement afin de diminuer dans l'avenir le SM chez les patients psychiatriques vulnérables.

Keywords: abdominal obesity; bipolar disorder; cardiovascular disease; depression; dyslipidemia; metabolic syndrome; review; schizophrenia.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Risk factors for metabolic syndrome dysregulations in psychiatric patients (left box) and the potential (future) clinical implications needed to minimize the unfavorable impact of these risk factors (middle box). HPA-axis, hypothalamic-pituitary-adrenal axis; MetS, metabolic syndrome
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Chesney E., Goodwin GM., Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014;13(2):153–160. - PMC - PubMed
    1. Vancampfort D., Stubbs B., Mitchell AJ., et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry. 2015;14(3):339–347. - PMC - PubMed
    1. Penninx BW., Milaneschi Y., Lamers F., Vogelzangs N. Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile. BMC Med. 2013;11:129. - PMC - PubMed
    1. Mitchell AJ., Vancampfort D., Sweers K., Van Winkel R., Yu W., De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders — a systematic review and meta-analysis. Schizophr Bull. 2013;39(2):306–318. - PMC - PubMed
    1. Mclntyre RS., Soczynska JK., Beyer JL., et al. Medical comorbidity in bipolar disorder: re-prioritizing unmet needs. Curr Opin Psychiatry. 2007;20(4):406–416. - PubMed

Publication types

MeSH terms

Substances