Metabolic Syndrome and Psychiatric Illness: Interactions, Pathophysiology, Assessment, and Treatment

We live in complicated times in which physicians easily can feel that they do not have enough time to read all the newly published information relevant to their practice. Books take longer to print, become easily outdated, and are not subject to the peer review process used for journal articles. Therefore, I usually encourage residents to use article reviews rather than books and to not even buy books, except for select textbooks or “classic” books at least 50 years old.

I definitively dislike the majority of new psychiatric books—the “editor” books in which several authors, without coordination, review a subject. Many of them appear to help only the authors in their academic career. My pessimistic view is that almost all of these are not worthwhile. This book is different in that a single author has written about an interesting subject, metabolic syndrome. The author is a psychiatrist with a Ph.D. in biopsychology and research experience in neuroendocrinology, focusing on the serotonin system.

First, and most importantly, I want to acknowledge the extraordinary merit of this book. It has 11 chapters and 970 references. Even assuming that there is some reference overlap between chapters, it is remarkable that the author was able to manage 900 references and summarize them in a coherent way, and some of them are relatively recent (2006).

I found two chapters particularly interesting. The historical discussion (Chapter 1) about Gerald Reaven’s work in defining Syndrome X was interesting and easy to read. Chapter 10 on nutritional supplements provides information on a subject unfamiliar to me.

The other seven chapters appear thorough and well researched: “Factors That Contribute to Metabolic Syndrome” (Chapter 2), “The Pathophysiology of Metabolic Syndrome” (Chapter 3), “Metabolic Syndrome and Psychiatric Illness” (Chapter 4), “Depression, Metabolic Syndrome, and Heart Disease” (Chapter 6), “Metabolic Syndrome, Insulin, and Alzheimer’s Disease” (Chapter 7), “Metabolic Syndrome, Sleep, and Sex” (Chapter 8), and “Diets for Weight Loss and Metabolic Syndrome” (Chapter 9).

The book has the subtitle “Interactions, Pathophysiology, Assessment, and Treatment.” I found the most disappointing part to be the section on assessments (described in Chapter 11), because it did not contain practical information on how to assess and diagnose patients with metabolic syndrome. I would have liked to see more practical recommendations on how to assess the syndrome and its various components.

In Chapter 5, “Psychiatric Medications and Metabolic Syndrome,” the information that antipsychotics may cause direct effects on lipids (1) and/or glucose (2) beyond those resulting from weight gain was not included. In my opinion this is a very important practical issue, as highlighted in several recent reviews (1, 2) . The author also did not comment on the potential of valproic acid to decrease total cholesterol levels (3) .

In summary, I found the book comprehensive for the most part, highly referenced, and easy to read, but it lacked practical information that can be easily used by clinicians. Chapter 11 was supposed to address that need, but it has only eight pages and no charts or tables. If the reader wants to become more familiar with the extensive literature on metabolic syndrome, this may be a good book. If the reader wants a straightforward presentation of practical recommendations for improving the care of psychiatric patients with metabolic syndrome, then it is not appropriate.