Skip to main content Accessibility help
×
Home

Metabolic syndrome in psychiatry: advances in understanding and management

  • Cyrus S. H. Ho, Melvyn W. B. Zhang, Anselm Mak and Roger C. M. Ho
  • Please note an addendum has been issued for this article.

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.

LEARNING OBJECTIVES

  1. Be familiar with the definition of metabolic syndrome and its parameters of measurement.
  2. Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.
  3. Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Metabolic syndrome in psychiatry: advances in understanding and management
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Metabolic syndrome in psychiatry: advances in understanding and management
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Metabolic syndrome in psychiatry: advances in understanding and management
      Available formats
      ×

Copyright

Corresponding author

Dr Roger C.M. Ho, Department of Psychological Medicine, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore 119 228. Email: pcmrhcm@nus.edu.sg

Footnotes

Hide All

Declaration of Interest

None.

Footnotes

References

Hide All
Alberti, KG, Eckel, RH, Grundy, SM et al (2009) 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 Association for the Study of Obesity. Circulation, 120: 1640–5.
Anagnostis, P, Athyros, VG, Tziomalos, K et al (2009) Clinical review: the pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. Journal of Clinical Endocrinology & Metabolism, 94: 2692–701.
Attvall, S, Fowelin, J, Lager, I et al (1993) Smoking induces insulin resistance: a potential link with the insulin resistance syndrome. Journal of Internal Medicine, 233: 327–32.
Balkau, B, Charles, MA (1999) Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabetic Medicine, 16: 442–3.
Bench, CJ, Friston, KJ, Brown, RG et al (1992) The anatomy of melancholia: focal abnormalities of cerebral blood flow in major depression. Psychological Medicine, 22: 607–15.
Bjomtorp, P, Rosmond, R (2000) The metabolic syndrome – a neuroendocrine disorder? British Journal of Nutrition, 83 (suppl 1): S4957.
Blackburn, GL, Hutter, MM, Harvey, AM et al (2009) Expert panel on weight loss surgery: executive report update. Obesity (Silver Spring), 17: 842–62.
Bloomgarden, ZT (2004) Definitions of the insulin resistance syndrome. The 1st World Congress on the Insulin Resistance Syndrome. Diabetes Care, 27: 824–30.
Capuron, L, Su, S, Miller, AH et al (2008) Depressive symptoms and metabolic syndrome: is inflammation the underlying link? Biological Psychiatry, 64: 896900.
Chang, HH, Chou, CH, Chen, PS et al (2009) High prevalence of metabolic disturbances in patients with bipolar disorder in Taiwan. Journal of Affective Disorders, 117: 124–9.
Cheng, C, Chiu, HJ, Loh, EW et al (2012) Association of the ADRA1A gene and the severity of metabolic abnormalities in patients with schizophrenia. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 36: 205–10.
Chi, MH, Chang, hH, Tzeng, NS et al (2013) The prevalence of metabolic syndrome in drug-naïve bipolar II disorder patients before and after twelve week pharmacological intervention. Journal of Affective Disorders, 146: 7983.
Chokka, P, Tancer, M, Yeragani, VK (2006) Metabolic syndrome: relevance to antidepressant treatment. Journal of Psychiatry Neuroscience, 31: 414.
Christoph, U, Correll, MD, Anne, M et al (2006) Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second generation antipsychotic drugs. Journal of Clinical Psychiatry, 67: 575–83.
Connolly, M, Kelly, C (2005) Lifestyle and physical health in schizophrenia. Advances in Psychiatric Treatment, 11: 125–32.
Correll, CU, Frederickson, AM, Kane, JM et al (2007) Does antipsychotic polypharmacy increase the risk for metabolic syndrome? Schizophrenia Research, 89: 91100.
de Hert, M, Dekker, JM, Wood, D et al (2009) Cardiovascular disease and diabetes in people with severe mental illnesses: position statement from the European Psychiatric Association (EPA), supported by the European Association for the study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry, 24: 412–24.
de la Torre, JC (2010) The vascular hypothesis of Alzheimer's disease: bench to bedside and beyond. Neurodegenerative Diseases, 7: 116–21.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) 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). JAMA, 285: 2486–97.
Fagiolini, A, Frank, E, Scott, JA et al (2005) Metabolic syndrome in bipolar disorder: findings from the Bipolar Disorder Centre for Pennsylvanians. Bipolar Disorder, 7: 424–30.
Fernandez-Egea, E, Bernardo, M, Parellada, E et al (2008a) Glucose abnormalities in the siblings of people with schizophrenia. Schizophrenia Research, 103: 110–3.
Fernandez-Egea, E, Miller, B, Bernardo, M et al (2008b) Parental history of type 2 disbetes in patients with nonaffective psychosis. Schizophrenia Research, 98: 302–6.
Fernandez-Egea, E, Miller, B, Garcia-Rizo, C et al (2011) Metabolic effects of olanzapine in patients with newly diagnosed psychosis. Journal of Clinical Psychopharmacology, 31: 154–9.
Fleischhacker, WW, Heikkinen, ME, Olie, JP et al (2010) 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. International Journal of Neuropsychopharmacology, 13: 1115–25.
Gebhardt, S, Theisen, FM, Haberhausen, M et al (2010) Body weight gain induced by atypical antipsychotics: an extension of the monozygotic twin and sib pair study. Journal of Clinical Pharmacy and Therapeutics, 35: 207–11.
Goeb, JL, Marco, S, Duhamel, A et al (2010) Metabolic side effects of risperidone in early onset schizophrenia (Abstract) [Article in French]. Encephale, 36: 242–52.
Grundy, SM, Brewer, HB Jr, Cleeman, JL et al (2004) Defnition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arteriosclerosis, Thrombosis, and Vascular Biology, 24: e138.
Gurnell, M (2001) Endocrinology: Medical Masterclass. Royal College of Physicians.
Hansen, T, Ingason, A, Djurovic, S et al (2011) At risk variant in TCF7L2 for type 2 diabetes increases risk of schizophrenia. Biological Psychiatry, 70: 5963.
Heppner, PS, Lohr, JB, Kash, TP et al (2012) Metabolic syndrome: relative risk associated with post-traumatic stress disorder (PTSD) severity and antipsychotic medication use. Psychosomatics, 53: 550–8.
Holt, R, Abdelrahman, T, Hirsch, M et al (2010) The prevalence of undiagnosed metabolic abnormalities in people with serious mental illnesses. Journal of Psychopharmacology, 24: 867–73.
Hope, S, Melle, I, Aukrust, P et al (2009) Similar immune profile in bipolar disorder and schizophrenia: Selective increase in soluble tumor necrosis factor receptor I and von Willebrand factor. Bipolar Disorder, 11: 726–34.
Howren, MB, Lamkin, DM, Suls, J (2009) Associations of depression with C-reactive protein, IL-1 and IL-6: a meta-analysis. Psychosomatic Medicine, 71: 171–86.
International Diabetes Federation (2006) The IDF Consensus Worldwide Definition of the Metabolic Syndrome. IDF.
Kahl, KG, Bens, S, Ziegler, K et al (2006) Cortisol, the cortisoldehydroepiandrosterone ratio, and proinflammatory cytokines in patients with current major depressive disorder comorbid with borderline personality disorder. Biological Psychiatry, 59: 667–71.
Kahl, KG, Greggersen, W, Schweiger, U et al (2013) Prevalence of the metabolic syndrome in patients with borderline personality disorder: results from a cross-sectional study. European Archives of Psychiatry and Clinical Neuroscience, 263: 205–13.
Kassi, E, Pervanidou, P, Kaltsas, G et al (2011) Metabolic syndrome: definition and controversies. BMC Medicine, 9: 48.
Kim, YK, Jung, HG, Myint, AM et al (2007) Imbalance between proinflammatory and anti-inflammatory cytokines in bipolar disorder. Journal of Affective Disorders, 104: 91–5.
Kim, MK, Kim, SH, Yu, HS et al (2012) The effect of clozapine on the AMPK-ACC-CPT1 pathway in the rat frontal cortex. International Journal of Neuropsychopharmacology, 15: 907–17.
Koivistoinen, T, Hutri-Kahonen, N, Juonala, M et al (2009) Metabolic syndrome and carotid intima media thickness in the Health 2000 Survey. Atherosclerosis, 204: 276–81.
Koponen, HJ, Hakko, HH, Saari, KM et al (2010) The prevalence and predictive value of individual criteria for metabolic syndrome in schizophrenia: a Northern Finland 1966 Birth Cohort Study. World Journal of Biological Psychiatry, 11: 262–7.
Kral, JG, Buckley, MC, Kissileff, HR et al (2001) Metabolic correlates of eating behaviour in severe obesity. International journal of obesity and related metabolic disorders, 25: 258–64.
Lee, DH, Blomhoff, R, Jacobs, DR Jr (2004) Is serum gamma glutamyltransferase a marker of oxidative stress? Free Radical Research, 38: 535–9.
Lee, NY, Kim, SH, Cho, B et al (2010) Patients taking medications for bipolar disorder are more prone to metabolic syndrome than Korea's general population. Progress in Neuropsychopharmacology and Biological Psychiatry, 34: 1243–9.
Lee, AK, Bishop, JR (2011) Pharmacogenetics of leptin in antipsychotic-associated weight gain and obesity-related complications. Pharmacogenomics, 12: 9991016.
Maayan, L, Vakhrusheva, J, Correll, C (2010) Effectiveness of medications used to attenuate antipsychotic-related weight gain and metabolic abnormalities: a systematic review and meta-analysis. Neuropsychopharmacology, 35: 1520–30.
McElroy, SL, Guerdjikova, AI, Martens, B et al (2009) Role of antiepileptic drugs in the management of eating disorders. CNS Drugs, 23: 139–56.
McEvoy, JP, Meyer, JM, Goff, DC et al (2005) 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. Schizophrenia Research, 80: 918.
McLaughlin, T, Abbasi, F, Lamendola, C et al (2002) Differentiation between obesity and insulin resistance in the association with C-reactive protein. Circulation, 106: 2908–12.
McIntyre, RS, Woldeyohannes, HO, Soczynska, JK et al (2010) The rate of metabolic syndrome in euthymic Canadian individuals with bipolar I/II disorder. Advances in Therapy, 27: 828–36.
McIntyre, RS, Alsuwaidan, M, Goldstein, BI et al (2012) The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid metabolic disorders. Annals of Clinical Psychiatry, 24: 6981.
Musselman, DL, Evans, DL, Nemeroff, CB (1998) The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Archives of General Psychiatry, 55: 580–92.
Na, KS, Kim, WH, Jung, HY et al (2012) Relationship between infiammation and metabolic syndrome following treatment with paliperidone for schizophrenia. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 39: 295300.
Nauck, MA (2011) Incretin-based therapies for type 2 diabetes mellitus: properties, functions, and clinical implications. American Journal of Medicine, 124 (1 suppl): S318.
Newcomer, JW (2007) Metabolic syndrome and mental illness. American Journal of Managed Care, 13 (suppl 7): S1707.
Oh, JH, Kim, TH, Sohn, YW et al (2011) Association of serum alanine aminotransferase and γ-glutamyltransferase levels within the reference range with metabolic syndrome and non-alcoholic fatty liver disease. Korean Journal of Hepatology, 17: 2736.
Papanastasiou, E (2012) Interventions for the metabolic syndrome in schizophrenia: a review. Therapeutic Advances in Endocrinology and Metabolism, 3: 141–62.
Park, SH, Kim, BI, Yun, JW et al (2004) Insulin resistance and C-reactive protein as independent risk factors for non-alcoholic fatty liver disease in non-obese Asian men. Journal of Gastroenterology and Hepatology, 19: 694–8.
Paslakis, G, Gilles, M, Lederbogen, F et al (2011) The effect of a 4 week treatment with reboxetine on metabolic parameters of depressed in-patients. European Archives of Psychiatry and Neurological Sciences, 261: 173–7.
Patel, SB, Reams, GP, Spear, RM et al (2008) Leptin: linking obesity, the metabolic syndrome, and cardiovascular disease. Current Hypertension Reports, 10: 131–7.
Potenza, MV, Mechanick, JI (2009) The metabolic syndrome: definition, global impact, and pathophysiology. Nutrition in Clinical Practice, 24: 560–77.
Praharaj, SK, Jana, AK, Goyal, N et al (2011) Metformin for olanzapine-induced weight gain: a systematic review and meta-analysis. British Journal of Clinical Pharmacology, 71: 377–82.
Purnell, JQ, Kahn, SE, Samuels, MH et al (2009) Enhanced cortisol production rates, free cortisol, and 11beta-HSD-1 expression correlate with visceral fat and insulin resistance in men: effect of weight loss. American Journal of Physiology, Endocrinology and Metabolism, 296: E3517.
Reynolds, GP, Templeman, LA, Zhang, ZJ (2005) The role of 5-HT2C receptor polymorphisms in the pharmacogenetics of antipsychotic drug treatment. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 29: 1021–8.
Roberts, RO, Geda, YE, Knopman, DS et al (2010) Metabolic syndrome, inflammation, and nonamnestic mild cognitive impairment in older persons: a population-based study. Alzheimer Disease and Associated Disorders, 24: 11–8.
Ruzickova, M, Slaney, C, Garnham, J et al (2003) Clinical features of bipolar disorder with and without comorbid diabetes mellitus. Canadian Journal of Psychiatry, 48: 458–61.
Saddichha, S, Manjunatha, N, Ameen, S et al (2008) Metabolic syndrome in first episode schizophrenia: a randomized double-blind controlled, short term perspective study. Schizophrenia Research, 101: 266–72.
Skilton, MR, Moulin, P, Terra, JL et al (2007) Associations between anxiety, depression, and the metabolic syndrome. Biological Psychiatry, 62: 1251–7.
Sutherland, JP, McKinley, B, Eckel, RH (2004) The metabolic syndrome and inflammation. Metabolic Syndrome and Related Disorders, 2: 82104.
Takeuchi, T, Nakao, M, Nomura, K et al (2009) Association of the metabolic syndrome with depression and anxiety in Japanese men: a 1-year cohort study. Diabetes/Metabolism Research and Reviews, 25: 762–7.
Taylor, AE, Hubbard, J, Anderson, EJ (1999) Impact of binge eating on metabolic and leptin dynamics in normal young women. Journal of Clinical Endocrinology & Metabolism, 84: 428–34.
Une, K, Takei, YA, Tomita, N et al (2011) Adiponectin in plasma and cerebrospinal fluid in MCI and Alzheimer's disease. European Journal of Neurology, 18: 1006–9.
van Himbergen, TM, Beiser, AS, Ai, M et al (2012) Biomarkers for insulin resistance and inflammation and the risk for all-cause dementia and Alzheimer disease: results from the Framingham Heart Study. Archives of Neurology, 69: 594600.
Vuksan-Cusa, B, Sagud, M, Jakovljevic, M et al (2012) Association between C-reactive protein and homocysteine with the subcomponents of metabolic syndrome in stable patients with bipolar disorder and schizophrenia. Nordic Journal of Psychiatry, PMID: 23228159 [epub ahead of print].
Wojciech, J, Szmitkowski, M (2007) Effects of ethanol on metabolic syndrome. Polish Archives of Internal Medicine, 117: 306–11.
World Health Organization (1999) Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. World Health Organization.
Yaffe, K, Kanaya, A, Lindquist, K et al (2004) The metabolic syndrome, inflammation, and risk of cognitive decline. JAMA, 292: 2237–42.
Yates, KF, Sweat, V, Yau, PL et al (2012) Impact of metabolic syndrome on cognition and brain: a selected review of the literature. Arteriosclerosis, Thrombosis, and Vascular Biology, 32: 2060–7.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Metabolic syndrome in psychiatry: advances in understanding and management

  • Cyrus S. H. Ho, Melvyn W. B. Zhang, Anselm Mak and Roger C. M. Ho
  • Please note an addendum has been issued for this article.
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *



An addendum has published for this article: