Saccaro Luigi F, Aimo Alberto, Panichella Giorgia, Sentissi Othman
Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Psychiatry Department, Geneva University Hospital, Geneva, Switzerland.
Front Psychiatry. 2024 Mar 4;15:1343427. doi: 10.3389/fpsyt.2024.1343427. eCollection 2024.
People with psychosis spectrum disorders (PSD) face an elevated risk of metabolic syndrome (MetS), which may reduce their life expectancy by nearly 20%. Pinpointing the shared and specific characteristics and clinical implications of MetS in PSD is crucial for designing interventions to reduce this risk, but an up-to-date review on MetS across the psychosis spectrum is lacking.
This narrative review fills this gap by examining the clinical literature on characteristics and implications of MetS in both distinct PSD and transdiagnostically, i.e., across traditional categorical diagnoses, with a focus on psychiatric and cardio-metabolic management.
We discuss common and specific characteristics of MetS in PSD, as well as factors contributing to MetS development in PSD patients, including unhealthy lifestyle factors, genetic predisposition, pro-inflammatory state, drugs consumption, antipsychotic medication, and psychotic symptoms. We highlight the importance of early identification and management of cardio-metabolic risk in PSD patients, as well as the existing gaps in the literature, for instance in the screening for MetS in younger PSD patients. We compare hypotheses-generating clinical associations and characteristics of MetS in different PSD, concluding by reviewing the existing recommendations and challenges in screening, monitoring, and managing MetS in PSD.
Early identification and management of MetS are crucial to mitigate the long-term cardio-metabolic toll in PSD patients. Interventions should focus on healthy lifestyle and appropriate pharmacological and behavioral interventions. Further translational and clinical research is needed to develop targeted interventions and personalized treatment approaches for this vulnerable population, aiming at improving physical health and overall well-being.
患有精神病性谱系障碍（PSD）的人群面临代谢综合征（MetS）风险升高的问题，这可能使其预期寿命缩短近20%。明确PSD中MetS的共同和特定特征以及临床意义对于设计降低该风险的干预措施至关重要，但目前缺乏对整个精神病性谱系中MetS的最新综述。
本叙述性综述通过审视关于MetS在不同PSD以及跨诊断（即跨越传统分类诊断）中的特征和意义的临床文献来填补这一空白，重点关注精神科和心脏代谢管理。
我们讨论了PSD中MetS的共同和特定特征，以及导致PSD患者发生MetS的因素，包括不健康的生活方式因素、遗传易感性、促炎状态、药物使用、抗精神病药物以及精神病性症状。我们强调了早期识别和管理PSD患者心脏代谢风险的重要性，以及文献中存在的空白，例如在年轻PSD患者中筛查MetS方面。我们比较了不同PSD中产生假设的临床关联和MetS特征，最后回顾了在PSD中筛查、监测和管理MetS的现有建议及挑战。
早期识别和管理MetS对于减轻PSD患者长期的心脏代谢负担至关重要。干预措施应侧重于健康的生活方式以及适当的药物和行为干预。需要进一步的转化和临床研究来为这一脆弱人群开发有针对性的干预措施和个性化治疗方法，以改善身体健康和整体幸福感。
