Metabolic Syndrome and Psychiatric Illness: Interactions, Pathophysiology, Assessment and Treatment -  Scott D Mendelson

Metabolic Syndrome and Psychiatric Illness: Interactions, Pathophysiology, Assessment and Treatment (eBook)

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2007 | 1. Auflage
224 Seiten
Elsevier Science (Verlag)
978-0-08-055652-9 (ISBN)
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Metabolic syndrome is a set of risk factors that includes: abdominal obesity, a decreased ability to process glucose (insulin resistance), dyslipidemia (unhealthy lipid levels), and hypertension. Patients who have this syndrome have been shown to be at an increased risk of developing cardiovascular disease and/or type 2 diabetes. Metabolic syndrome is a common condition that goes by many names (dysmetabolic syndrome, syndrome X, insulin resistance syndrome, obesity syndrome, and Reaven's syndrome).
This is the first book to fully explain the relationships between psychiatric illness, Metabolic Syndrome, diet, sleep, exercise, medications, and lifestyle choices. Metabolic Syndrome is a major risk factor in Major Depression, Alzheimer's Disease, Sleep Disorders, Sexual Dysfunction, Fibromyalgia, and several other illnesses of psychiatric significance. Conversely, some psychiatric illnesses tend to predispose patients to Metabolic Syndrome. Of further interest is the fact that some of the medications used in the treatment of psychiatric illnesses have been found to cause or exacerbate Metabolic Syndrome.
The author here provides basic information about what genetic predispositions, medical conditions, and lifestyle choices make Metabolic Syndrome more likely to occur. Among the contributing factors that are discussed are genetics, habitual intake of high glycemic index carbohydrates, fructose, saturated fats, trans fatty acids, vitamins, micronutrients, obesity, smoking, and lack of exercise.
The author describes the actual mechanisms by which Metabolic Syndrome progresses and causes damage in the body, including the action of insulin and the pathophysiology of insulin resistance. Details are provided on what occurs in the liver, pancreas, muscle, fat cells, and immune system as Metabolic Syndrome progresses. New findings are presented on fat cells, including the fact that they are beginning to be considered as endocrine cells. There is a substantive discussion of leptin, which is one of the important adipocytokines. Also carbohydrate, 'bad fats', inflammation, oxidative damage, over-stimulation of the 'fight or flight' system, and high levels of the stress hormone cortisol can actually cause the manifestations of Metabolic Syndrome. These explanations set the stage for an explanation of the inter-relationships between Metabolic Syndrome, psychiatric illness, dementia and effects of not only diet and life choices, but also the effects of psychiatric medications.
Finally, there is an important and unique section on the relationship between Metabolic Syndrome and various psychiatric illnesses, and how they exacerbate each other. The significance of Metabolic Syndrome in Major Depression, Bipolar Affective Disorder, Schizophrenia, fibromyalgia and Polycystic Ovary Disease is vast and it is important to realise the effects of psychiatric medications on Metabolic Syndrome. The author discusses antidepressants, mood stabilizers and the new atypical antipsychotics. There are dramatic differences among medications in the way they affect Metabolic Syndrome and pharmaceutical companies will want to promote patient awareness with this book.
Metabolic syndrome is a set of risk factors that includes: abdominal obesity, a decreased ability to process glucose (insulin resistance), dyslipidemia (unhealthy lipid levels), and hypertension. Patients who have this syndrome have been shown to be at an increased risk of developing cardiovascular disease and/or type 2 diabetes. Metabolic syndrome is a common condition that goes by many names (dysmetabolic syndrome, syndrome X, insulin resistance syndrome, obesity syndrome, and Reaven's syndrome). This is the first book to fully explain the relationships between psychiatric illness, Metabolic Syndrome, diet, sleep, exercise, medications, and lifestyle choices. Metabolic Syndrome is a major risk factor in Major Depression, Alzheimer's Disease, Sleep Disorders, Sexual Dysfunction, Fibromyalgia, and several other illnesses of psychiatric significance. Conversely, some psychiatric illnesses tend to predispose patients to Metabolic Syndrome. Of further interest is the fact that some of the medications used in the treatment of psychiatric illnesses have been found to cause or exacerbate Metabolic Syndrome. The author here provides basic information about what genetic predispositions, medical conditions, and lifestyle choices make Metabolic Syndrome more likely to occur. Among the contributing factors that are discussed are genetics, habitual intake of high glycemic index carbohydrates, fructose, saturated fats, trans fatty acids, vitamins, micronutrients, obesity, smoking, and lack of exercise. The author describes the actual mechanisms by which Metabolic Syndrome progresses and causes damage in the body, including the action of insulin and the pathophysiology of insulin resistance. Details are provided on what occurs in the liver, pancreas, muscle, fat cells, and immune system as Metabolic Syndrome progresses. New findings are presented on fat cells, including the fact that they are beginning to be considered as endocrine cells. There is a substantive discussion of leptin, which is one of the important adipocytokines. Also carbohydrate, 'bad fats', inflammation, oxidative damage, over-stimulation of the 'fight or flight' system, and high levels of the stress hormone cortisol can actually cause the manifestations of Metabolic Syndrome. These explanations set the stage for an explanation of the inter-relationships between Metabolic Syndrome, psychiatric illness, dementia and effects of not only diet and life choices, but also the effects of psychiatric medications. Finally, there is an important and unique section on the relationship between Metabolic Syndrome and various psychiatric illnesses, and how they exacerbate each other. The significance of Metabolic Syndrome in Major Depression, Bipolar Affective Disorder, Schizophrenia, fibromyalgia and Polycystic Ovary Disease is vast and it is important to realise the effects of psychiatric medications on Metabolic Syndrome. The author discusses antidepressants, mood stabilizers and the new atypical antipsychotics. There are dramatic differences among medications in the way they affect Metabolic Syndrome and pharmaceutical companies will want to promote patient awareness with this book.

Front Cover 1
Metabolic Syndrome and Psychiatric Illness 4
Copyright Page 5
Table of Contents 6
ACKNOWLEDGMENTS 12
FOREWORD 14
Chapter 1 Gerald Reaven and the Discovery of Syndrome X 18
References 26
Chapter 2 Factors that Contribute to Metabolic Syndrome 28
Genetics 28
Carbohydrates and the Glycemic Index 29
Fructose 31
Fiber 31
Fatty Acids and how they Differ 32
Saturated Fat 33
Omega-3 and Omega-6 33
Trans Fats 34
Micronutrients 35
Salt 37
Exercise 38
Smoking and Drinking 38
Obesity 39
References 40
Chapter 3 The Pathophysiology of Metabolic Syndrome 44
Insulin 44
Insulin Resistance and Compensatory Hyperinsulinemia 45
The Rise of the Adipocyte 46
Leptin 47
Adipocytes, Insulin, and Metabolic Syndrome 49
Muscle 50
The Liver 51
The Liver, Fat, and Insulin Resistance 52
Non-alcoholic Fatty Liver Disease 53
Hormonal Interactions in the Liver 54
Peroxisome Proliferation Activating Receptors 54
Inflammation 55
Oxidative Stress 56
Lipotoxicity 58
Asymmetrical Dimethylarginine 59
Stress and Cortisol 60
References 61
Chapter 4 Metabolic Syndrome and Psychiatric Illness 66
Major Depression 66
Insulin Resistance and Major Depression 67
Stress 68
Inflammation 70
Obesity 71
The Liver, Metabolic Syndrome and Major Depression 72
Cholesterol and Suicide 73
Seasonal Affective Disorder 74
Bipolar Affective Disorder 76
Anxiety Disorders 77
Schizophrenia 80
Metabolic Syndrome, Schizophrenia, and the NMDA Receptor 81
Fibromyalgia 82
Polycystic Ovary Disease 83
References 83
Chapter 5 Psychiatric Medications and Metabolic Syndrome 90
Antidepressants 90
Mood Stabilizers 92
Atypical Antipsychotics 93
Atypical Antipsychotics and Weight Gain 94
Genetics and Atypical Antipsychotic-induced Weight Gain 94
Mechanisms of Atypical Antipsychotic-induced Weight Gain 95
Atypical Antipsychotics and Insulin Resistance 96
Effects of Atypical Antipsychotics on Serum Lipids 97
Atypical Antipsychotics and Diabetes 98
Hyperprolactinemia 99
Guidelines for Monitoring Patients on Atypical Antipsychotics 100
Add-on Treatments to Counter Weight Gain and Metabolic Syndrome 101
Difficult Choices Must be Made 103
References 103
Chapter 6 Depression, Metabolic Syndrome, and Heart Disease 110
Dysrhythmias 111
Heart Failure 112
Ischemic Heart Disease and Myocardial Infarction 112
Platelet Hyperactivity 113
Inflammation 114
Stress 115
Lipid Abnormalities 116
Does Treating Major Depression Reduce Cardiac Risk? 117
References 118
Chapter 7 Metabolic Syndrome, Insulin and Alzheimer’s Disease 122
The Stages of Alzheimer’s Disease 123
Plaques and Tangles 124
Insulin and Alzheimer’s Disease 124
Insulin-Degrading Enzyme and Amyloid 126
Insulin and Tangled Tau 127
Inflammation and Alzheimer’s Disease 128
References 130
Chapter 8 Metabolic Syndrome, Sleep, and Sex 132
Sleep Apnea 132
Hypoxia 133
Sleep Apnea, Stress, and Metabolic Syndrome 134
Smuggling, Snoring and the Velopharynx 135
Sleep, Mood and Glycogen Synthase Kinase-3 (GSK-3) 136
Sleep Apnea and Alzheimer’s Disease 137
Inadequate Sleep and Altered Sleep Schedules 138
Metabolic Syndrome and Sex 139
References 142
Chapter 9 Diets for Weight Loss and Metabolic Syndrome 146
Low-Fat, High-Carbohydrate Diets 147
A Few Words about Protein 148
Diet, Appetite, and Satiety 149
Thermic Effects of Food 151
The Atkins Diet 151
Other Low-Carbohydrate Diets 153
Gerald Reaven’s Syndrome X Diet 153
The Mediterranean Diet 154
The Bottom Line on Diet 155
References 156
Chapter 10 Nutritional Supplements and Metabolic Syndrome 158
Acetyl-Carnitine 158
Alpha-Lipoic Acid 160
Carnosine 161
Chocolate 163
Chromium 164
Coenzyme Q10 166
Curcumin 167
DHEA 168
Fish Oil (Omega-3 Fatty Acids, EPA, DHA) 169
Ginseng 174
Leucine 176
Niacin (Nicotinic Acid, Vitamin B3) 179
Resveratrol 181
S-adenosylmethionine (SAMe) 183
Silymarin 188
Vanadium 189
Vitamin D 191
References 193
Chapter 11 Conclusion: Metabolic Syndrome and what to do about it 204
The First Step 205
Diet 205
Exercise 207
Sleep 207
Stress Reduction 208
Bad Habits 209
Treat Co-morbid Illness 209
Remember Hippocrates 209
References 210
INDEX 212

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