Impaired hormonal regulation of appetite in schizophrenia: A narrative review dissecting intrinsic mechanisms and the effects of antipsychotics

PSYCHONEUROENDOCRINOLOGY

卷:119

Review

Lis, Michal¹  Stanczykiewicz, Bartlomiej²  Liskiewicz, Pawel³  Misiak, Blazej⁴ 

[1] Minist Interior Warsaw, Cent Clin Hosp, Clin Dept Internal Dis Endocrinol & Diabetol, Woloska 137 St, PL-02507 Warsaw, Poland

[2] Wroclaw Med Univ, Dept Nervous Syst Dis, Bartla 5 St, PL-51618 Wroclaw, Poland

[3] Pomeranian Med Univ, Dept Psychiat, Broniewskiego 26 St, PL-71460 Szczecin, Poland

[4] Wroclaw Med Univ, Dept Genet, Marcinkowskiego 1 St, PL-50368 Wroclaw, Poland

关键词: Endocrine;    Adipose tissue;    Glucose;    Physical health;    Severe mental illness;   

DOI  :  10.1016/j.psyneuen.2020.104744

来源: Elsevier

【 摘 要 】

Cardiometabolic diseases are the main contributor of reduced life expectancy in patients with schizophrenia. It is now widely accepted that antipsychotic treatment plays an important role in the development of obesity and its consequences. However, some intrinsic mechanisms need to be taken into consideration. One of these mechanisms might be related to impaired hormonal regulation of appetite in this group of patients. In this narrative review, we aimed to dissect impairments of appetite-regulating hormones attributable to intrinsic mechanisms and those related to medication effects. Early hormonal alterations that might be associated with intrinsic mechanisms include low levels of leptin and glucagon-like peptide-1 (GLP-1) together with elevated insulin levels in first-episode psychosis (FEP) patients. However, evidence regarding low GLP-1 levels in FEP patients is based on one large study. In turn, multiple-episode schizophrenia patients show elevated levels of insulin, leptin and orexin A together with decreased levels of adiponectin. In addition, patients receiving olanzapine may present with low ghrelin levels. Post mortem studies have also demonstrated reduced number of neuropeptide Y neurons in the prefrontal cortex of patients with schizophrenia. Treatment with certain second-generation antipsychotics may also point to these alterations. Although our understanding of hormonal regulation of appetite in schizophrenia has largely been improved, several limitations and directions for future studies need to be addressed. This is of particular importance since several novel pharmacological interventions for obesity and diabetes have already been developed and translation of these developments to the treatment of cardiometabolic comorbidities in schizophrenia patients is needed.

【 授权许可】

Free