The common pathophysiology underlying the metabolic syndrome, schizophrenia and depression. A review

Abstract

Background. There is a growing interest in metabolic alterations in patients with psychiatric disorders due to their increased risk for metabolic syndrome (MetS) development. Inflammation is known to underlie the pathophysiology of schizophrenia and depression as well as MetS. Vulnerability factors for schizophrenia/depression and MetS hence appear to be shared. Methods and Results. Based on a Web of Science search, this review examines current evidence for MetS pathophysiology involving dysregulation of adipose tissue signaling -adipokines and pro-inflammatory cytokine, both also known to be aberrant in schizophrenia/depression. Further, gender differences in the incidence and course of schizophrenia/ depression were reported. The disturbances linked to the MetS are also described. Therefore, this review further maps the gender differences in the psychiatric-metabolic comorbidities. Conclusion. There is evidence supporting a pathological predisposition to MetS in both schizophrenia and depression in both humans and animal models. This predisposition is dramatically enhanced by antipsychotic medication. Further, there are gender differences from clinical findings suggesting women with schizophrenia/depression are more vulnerable to MetS development. This has not yet been assessed in animal studies. We suggest further validation of existing schizophrenia and depression animal models for the assessment of metabolic disturbances to provide tools for developing new antipsychotics and antidepressants with "metabolically inert" profile or improving the metabolic status in schizophrenic/depressed patients.

Biological rhythms, metabolic syndrome and current depressive episode in a community sample

“…Depression and MetS share pathophysiological pathways such as disturbances in the hypothalamic-pituitary-adrenal axis (HPA), low-grade chronic inflammation and changes in appetite hormones and sleep abnormalities (Kucerova et al, 2015;Martinac et al, 2014;Santos et al, 2007;Scharnholz et al, 2014). Moreover, higher levels of cortisol (stress hormone) are present in depression and metabolic syndrome (Kucerova et al, 2015;Martinac et al, 2014).…”

“…Depression and MetS share pathophysiological pathways such as disturbances in the hypothalamic-pituitary-adrenal axis (HPA), low-grade chronic inflammation and changes in appetite hormones and sleep abnormalities (Kucerova et al, 2015;Martinac et al, 2014;Santos et al, 2007;Scharnholz et al, 2014). Moreover, higher levels of cortisol (stress hormone) are present in depression and metabolic syndrome (Kucerova et al, 2015;Martinac et al, 2014). Recently, Barandas et al, 2015, highlighted in a review article that the disturbed biological rhythms may elevate the risk of both metabolic and psychiatric disorders, including depression, by coordinating key systems and physiological processes, such as the reward system, the stress response, and energy utilization (Barandas et al, 2015).…”

Etiopathogenesis of metabolic syndrome in schizophrenia – recent findings

“…53, No. 1, p. 27-42 gu za nastanak metaboličkog sindroma, ali i shizofrenog oboljenja 12,13 . Primjerice, značajno povišena koncentracija proupalnih citokina IL1β, IL-6 i TNF-α te C reaktivnog proteina uočena je u serumu i cerebrospinalnoj tekućini pacijenata sa shizofrenijom koji nisu uzimali antipsihotične lijekove ili su ih uzimali u vrlo malim dozama 13,14 .…”

“…1, p. 27-42 gu za nastanak metaboličkog sindroma, ali i shizofrenog oboljenja 12,13 . Primjerice, značajno povišena koncentracija proupalnih citokina IL1β, IL-6 i TNF-α te C reaktivnog proteina uočena je u serumu i cerebrospinalnoj tekućini pacijenata sa shizofrenijom koji nisu uzimali antipsihotične lijekove ili su ih uzimali u vrlo malim dozama 13,14 . Osim toga, zamijećeno je da uzimanje selektivnih inhibitora ciklooksigeneze-2, poput celekoksiba, paralelno s antipsihotičnom terapijom, može smanjiti težinu kliničkih simptoma i kognitivnih deficita koji se javljaju u pacijenata sa shizofrenijom 15,16 .…”

“…Nije naodmet spomenuti da su u pacijenata sa shizofrenijom uočene i zanimljive razlike u značajkama prehrane između spolova; primjerice, pojedine studije pokazale su da su muškarci skloniji nezdravom načinu prehrane negoli žene, koji uključuje, između ostalog, smanjen unos voća, povrća i mlijeka te pojačanu konzumaciju alkohola 39,63,66 . Najnovije spoznaje o povezanosti prehrane i metaboličkog sindroma ukazuju na zanimljivu mogućnost da prehrana u pacijenata sa shizofrenijom zapravo pogoduje aktivaciji upalnog odgovora u organizmu; pojačano je stanje upale, kao što je već spomenuto, uključeno u nastanak rezistencije na inzulin i etiopatogenezu dijabetesa tipa 2 8,13 . Potrebno je istaknuti da masne kiseline posjeduju varijabilni upalni potencijal; primjerice, SFA, koje, kao što je prethodno spomenuto, oboljeli od shizofrenije unose u organizam u većoj količini negoli ostale masne kiseline, potiču nastanak upalnog odgovora 39,67 .…”