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Approach to the metabolic syndrome in psychiatric patients

Abstract:

The metabolic syndrome (MS) is a pathologic condition characterized by the coexistence of abdo-inal obesity, insulin resistance, hypertension, and hyperlipidemia, accompanied by endothelial dysfunction, chronic inflammation, hypercoagulability states, and adiposopathy. This conglomerate is related with an increase in the risk of cardiovascular disease, type 1 diabetes mellitus, and other chronic non-communicable diseases of high prevalence, morbidity, and mortality. Patients with mental disorders have also been demonstrated to exhibit a greater risk for these cardiometabolic disturbances, especially those with depression. Although historically these problems v/ere prominently attributed to atypical antipsychotics, patients with mental disorders who do not receive these drugs also display higher than average cardiometabolic risk. The pathophysiologic phenomena implicated encompass numerous neurohumoral alterations with a severe metabolic impact, particularly through the hypothalamic-pituitary-adrenal axis, and the sympathetic nervous system. This review exposes the mechanisms possibly involved in the relationship between MS and mental disorders, with an emphasis on depression.