Metabolic Syndrome and Bipolar Disorder: What Should Psychiatrists Know?

Abstract

SUMMARYThis paper reviews the association between bipolar disorder (BD) and metabolic syndrome (MetS), focusing on the etiopathogenetic and pathophysiological aspects of this association and on the recommendations for preventing and managing MetS in patients with BD. We conducted a nonsystematic literature review by means of a MEDLINE search. The exact causal relationship between MetS and BD is still uncertain. The side effects of psychotropic medications may be a major contributor to the increased rates of MetS in patients with BD. Other factors such as unhealthy lifestyles, common neuroendocrine and immunoinflammatory abnormalities, and genetic vulnerability may also play a role in explaining the high rates of MetS in BD. Strategies to prevent and treat the MetS and its cardiovascular consequences in patients with BD include accurate screening and monitoring of the patient and appropriate psychoeducation on weight control, healthy nutrition, and increased physical activity. When deciding on pharmacological therapy for the treatment of the components of the MetS, drug interactions and the effects of the medications on mood must be taken into account.

Application of meta-analysis methods for identifying proteomic expression level differences

“…The finding of altered growth hormone in bipolar disease is consistent with the results from previous studies . Interestingly, low levels of growth hormone have been associated with insulin resistance that has also been found in other studies of bipolar disorder . This is the first report of alterations in the EN‐RAGE protein in association with bipolar disorder.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…Metabolic syndrome in particular is a highly prevalent comorbidity, present in 20‐65% of patients with BD 777. Defined as a cluster of clinical and biochemical features, including abdominal adiposity, hypertension, impaired fasting glucose, diabetes mellitus, and atherogenic dyslipidaemia,778 metabolic syndrome not only greatly increases an individual's risk for cardiovascular disease, diabetes mellitus, and premature mortality779 but also worsens bipolar clinical outcomes 780, 781.…”

Refining and integrating schizophrenia pathophysiology – Relevance of the allostatic load concept

“…In addition, schizophrenia is associated with high prevalence and incidence rates of physical health problems and reduced life expectancy up to 25-30 years due to medical morbidity and suicide risk (Casey et al, 2011;de Almeida et al, 2012). Notably, cardiovascular mortality is the core contributor of natural causes of death in this group of patients (Auquier et al, 2007) and the prevalence of metabolic syndrome in schizophrenia has been estimated at 37-63% (Correll, 2007).…”