Volume 3 Issue 1 January, 2013
The connection between mental illness and the metabolic syndrome is emerging as a public health question of importance to both mental health and primary care practitioners. Originally identified by Reaven as Syndrome X or the Insulin resistance syndrome, the magnitude of public health impact of the metabolic syndrome is reflected by a recently estimated prevalence of approximately 24% in adults in the United States.
Metabolic syndrome describes a cluster of risk factors of metabolic origin that are associated with an increased risk of cardiovascular morbidity and mortality. These risk factors include abdominal obesity, glycemic dysregulation, dyslipidemia, and elevated blood pressure. Metabolic syndrome is important to the practicing psychiatrist because of the association between some psychiatric disorders and the individual components of metabolic syndrome.
| Diagnostic criteria for metabolic syndrome from different sources | |||
| Criteria | ATP‐III | AHA | IDF |
| Waist circumference (cm) Men Women | ≥102 ≥88 | ≥102 ≥88 | ≥90 ≥80 |
| Blood pressure (mmHg) | ≥130/85 | ≥130/85 | ≥130/85 |
| High-density lipoprotein level (mmol/L) Men Women | <1.03 <1.30 | <1.03 <1.30 | <1.03 <1.30 |
| Fasting blood triglyceride level (mmol/L) | ≥1.7 | ≥1.7 | ≥1.7 |
| Fasting blood glucose level (mmol/L) | ≥6.1 | ≥5.6 | ≥5.6 |
| ATP III=National Cholesterol Education Program’s Adult Treatment Panel III. AHA = American Heart Association/National Heart, Lung and Blood Institute. IDF =International Diabetes Federation. Three of five criteria must be present to establish the diagnosis. Abnormal waist circumference plus any two of the other four criteria must be present to establish the diagnosis. |
The metabolic syndrome and psychiatric disorders appear to share common risk factors, including endocrine disturbances, dysregulation of the sympathetic nervous system, and behaviour patterns, such as physical inactivity, substance abuse and overeating. In addition, many of the commonly used pharmacological treatments for psychiatric disorders may intensify the medical burden in patients by causing weight gain and metabolic disturbances, including alterations in lipid and glucose metabolism, which can result in an increased risk for diabetes mellitus, hypertension, dyslipidaemia, cardiovascular disease and the metabolic syndrome. These may result in premature mortality observed in psychiatric patients and is also a major cause of treatment noncompliance, increased use of outpatient and inpatient services and consequently, higher healthcare costs.
Management: Although there is no treatment algorithm for the metabolic syndrome as a whole, the first‐line approach is treatment of individual components of the metabolic syndrome along with lifestyle modification, focusing on nutrition counseling for ongoing changes in diet and exercise. Psychiatrists should identify the risk factors, monitor the metabolic parameters & choose appropriate psychotropic medications for patients with co‐morbid metabolic syndrome.
Conclusion: Patients with severe mental illnesses, particularly schizophrenia and chronic mood disorders, are at risk of metabolic syndrome compared with the general population in several countries. Therefore, baseline and periodic medical evaluations should become a standard component in the ongoing assessment of these patients. Although individual risk factors associated with the metabolic syndrome are typically amenable to behavioral or pharmacologic treatment, management of these co‐morbidities in many patients with serious mental illness will require cooperation between psychiatrists and primary care physicians. Patient education and adequate control of psychiatric symptoms will also remain important parameters in achieving long‐term treatment success.
Vydehi Institute of Medical Sciences & Research Center, Bangalore
