Metabolic complications of psychotropic medications in psychiatric disorders:Emerging role of de novo lipogenesis and therapeutic consideration

Although significant advances have been made in understanding the pathophysiology of psychiatric disorders(PDs),therapeutic advances have not been very convincing.While psychotropic medications can reduce classical symptoms in patients with PDs,their long-term use has been reported to induce or exaggerate various pre-existing metabolic abnormalities including diabetes,obesity and non-alcoholic fatty liver disease(NAFLD).The mechanism(s)underlying these metabolic abnormalities is not clear;however,lipid/fatty acid accumulation due to enhanced de novo lipogenesis(DNL)has been shown to reduce membrane fluidity,increase oxidative stress and inflammation leading to the development of the aforementioned metabolic abnormalities.Intriguingly,emerging evidence suggest that DNL dysregulation and fatty acid accumulation could be the major mechanisms associated with the development of obesity,diabetes and NAFLD after long-term treatment with psychotropic medications in patients with PDs.In support of this,several adjunctive drugs comprising of anti-oxidants and antiinflammatory agents,that are used in treating PDs in combination with psychotropic medications,have been shown to reduce insulin resistance and development of NAFLD.In conclusion,the above evidence suggests that DNL could be a potential pathological factor associated with various metabolic abnormalities,and a new avenue for translational research and therapeutic drug designing in PDs.

Acute Metabolic Complications of Diabetes in the Oueme-Plateau Provincial Teaching Hospital: Epidemiological, Clinical, Paraclinical and Evolutionary Aspects

Introduction: Diabetes mellitus, a metabolic disease, is now an important public health problem across the world. Our aim was to study the epidemiological, clinical, paraclinical, and evolutionary aspects of acute metabolic complications (AMC) of diabetes in the endocrinology department of the Oueme-Plateau Provincial Teaching Hospital. Methods: This was a descriptive cross-sectional study with data collection based on the medical records of patients presenting with acute metabolic complications of diabetes in the endocrinology department of the Oueme-Plateau Provincial Teaching Hospital during the 3 years study period (from January 2020 to December 2022). Results: Over 788 patients hospitalized during the study period, 157 had an acute metabolic complication of diabetes, which is a hospital prevalence of 19.9%. Among these 157 cases, 140 were suitable for analysis and therefore constituted our study sample. The mean age of the patients was 49.9 ± 14.7 years, with 19 as minimum and 90 years as maximum. Most of them were women (52.4%). Hypertensive diabetics accounted for 54.9% of cases. Ketoacidosis was the most common complication (62.1%), followed by hyperosmolar hyperglycemic syndrome (23.6%) and hypoglycemia (14.3%). Infection (69.3%) and therapeutic noncompliance (22.9%) were the most common triggers. The average length period of their hospital stay was 7.1 ± 5.1 days, and the outcome was satisfactory in 87.9% of the cases. Unfortunately, there were 3.6% deaths during hospitalization. Conclusion: Acute metabolic complications of diabetes were dominated by ketoacidosis. Infection was the dominant factor in decompensation. Therapeutic education of diabetic patients as well as clinical and biological monitoring must be more stringent and rigorous.

Clinical Food Addiction Is Not Associated with Development of Metabolic Complications in Liver Transplant Recipients

Background and Aims:Given the increased risk of posttransplant metabolic syndrome(PTMS;defined by hypertension,diabetes mellitus and hyperlipidemia),we aimed to identify the potential role of food addiction in the development of metabolic complications in the post-liver transplant population.Methods:Inclusion criteria included adult liver transplant recipients followed at our institution between June 2016 and November 2016.Participants were administered a demographic survey as well as the Yale Food Assessment Scale 2.0,a 35-item questionnaire used to assess frequency of food addiction in accordance with the DSM-V guidelines of substance use disorders.Demographic and clinical data were collected.Results:Our study included 236 liver transplant recipients(139 males,97 females).The median(interquartile range[IQR])BMI of participants was 26.8 kg/m2(24.2,30.4),and median(IQR)time since transplantation was 50.9 months(19.6,119.8).The prevalence rates of hypertension,hypercholesterolemia and diabetes mellitus were 54.7%,25.0%and 27.1%,respectively.Twelve participants(5.1%)were found to have a diagnosis of food addiction.A diagnosis of food misuse was made in 94(39.8%)of the transplant recipients.Conclusions:Our findings are consistent with prior data that indicate high prevalence of metabolic complications among liver transplant recipients.Food addiction was not predictive of metabolic complications within this population.Nevertheless,we found that this population was at high risk of demonstrating symptoms of food misuse,and they were not likely to appreciate the risks of pathologic patterns of eating.Given the increasing risk of cardiovascular morbidity and mortality in this population,efforts should be made to identify risk factors for the development of PTMS.