Allostatic Load as a Tool for Monitoring Physiological Dysregulations and Comorbidities in Patients with Severe Mental Illnesses

Abstract

Severe mental illnesses like schizophrenia and bipolar disorder are disabling, chronic conditions that are often accompanied by medical comorbidities. In this theoretical article, we review the allostatic load model representing the "wear and tear" that chronic stress exacts on the brain and body. We propose an innovative way of monitoring physical and psychiatric comorbidities by integrating the allostatic load model into clinical practice. By interpreting peripheral biomarkers differently, medical professionals can calculate a simple, count-based, allostatic load index known to predict diverse stress-related pathologies. In addition to screening for comorbidities, allostatic load indices can be used to monitor the effects of pharmacological and psychosocial interventions. This framework can also be used to generate a dialogue between patient and practitioner to promote preventive and proactive approaches to health care.

Allostatic load and biological anthropology

“…Higher allostatic load is associated with lower cognitive functioning Karlamangla et al, 2014;Seeman et al, 1997Seeman et al, , 2001) and greater cognitive decline over time (Karlamangla et al, 2002;Seeman et al, 1997Seeman et al, , 2001 (Bizik et al, 2012;McEwen, 2004b), attention deficit disorder (Stewart, 2006), and bipolar disorder (Bizik et al, 2012;Ozerdem, 2015).…”

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

“…There are three lines of alterations in neurotransmission systems that underlie the concept of PAL: disturbances in dopaminergic and cholinergic transmissions (these are of particular relevance to comorbid substance use disorders), as well as opioidergic system alterations. In this vein, SGA may increase pre-existing elevations of endogenous opiates leading to subsequent alterations in "liking" processes within the reward system that result in hedonic preferences for sweet and fatty food products (Bizik et al, 2013;Juster et al, 2011). Several studies also suggest that antipsychotic treatment and comorbid cardiovascular diseases may underlie the development of progressive brain changes Hulshoff Pol and Kahn, 2008;Puri, 2011).…”

“…In this regard, it might be assumed that comorbid substance use disorders are an important source of AL in schizophrenia that accounts for clinical and neurobiological progression. The above mentioned PAL concept (Bizik et al, 2013;Juster et al, 2011) along with dopaminergic and cholinergic alterations may also provide interesting insights into addiction biology that is specific for schizophrenia patients. In this vein, substance use disorders are considered as deleterious 'self-healing' processes that are initiated by the patients due to antipsychotic treatment.…”

“…It should also be noted that antipsychotics might be involved in the development of PAL and thus exert deleterious effects (Bizik et al, 2013;Juster et al, 2011). In addition, it seems that AL in schizophrenia creates a vicious cycle that can be broken up by holistic approach interventions including both pharmacological and non-pharmacological interventions (Fig.…”

“…It should also be noted that the AL concept may provide insights into physical health disparities (Beckie, 2012) that constitute enormous burden in schizophrenia patients. Notably, AL index is a simple measure that reflects global biological alterations and might be useful in predicting and monitoring comorbidities in schizophrenia patients (Bizik et al, 2013;Juster et al, 2011). Elaboration of treatment strategies modifying AL markers associated with comorbid physical and mental health impairments is warranted.…”