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Director, Tardive Dyskinesia Assessment Clinic, Minneapolis Veterans Affairs Medical Center; Assistant Professor of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN
Published Online, May 19, 2009. www.theannals.com, DOI 10.1345/aph.1M083
Audience: The audience includes clinical psychiatrists, endocrinologists, immunologists, cardiologists, and clinical neuroscientists.
Purpose: To explore the relationship between the epidemiology and pathophysiology of the metabolic syndrome in psychiatric disorders, with special emphasis on the difficulties of establishing causal relationships among antipsychotics, the metabolic syndrome, and the metabolic effects of psychotropic agents in general.
Content: A short preface provides a summary highlighting the primary aims of the 9 chapters, which consist of fairly detailed reviews of various facets of the metabolic syndrome, including obesity, glucose abnormalities in schizophrenia, bipolar disorder and major depression, and insulin resistance in bipolar women. The opening chapter attempts to integrate evidence from viral and neurodevelopmental studies pointing to the role of inflammation in the pathophysiology of both schizophrenia and the metabolic syndrome; another chapter links a dysfunctional hypothalamic-pituitary-adrenal axis to both conditions. Two chapters explore the problems associated with hyperprolactinemia.
Usability: Several chapters provide a good review of conditions not usually associated with the metabolic syndrome—especially major depression—which, of course, is much more prevalent than schizophrenia. The authors have also emphasized various metabolic adverse effects of antidepressants and anticonvulsants and have stressed the lack of solid, long-term metabolic studies of these agents.
Highlights: The emphasis on the occurrence of metabolic issues in conditions other than schizophrenia is welcome information and deserves more study. A number of chapters have helpful tables and flow-charts that supplement the text. Several authors have provided clinically useful information on screening. In some instances, the authors have nicely integrated findings from bench research with clinical applications and data. Reference lists are generally current, with a number of citations from 2007 and 2008.
Limitations: The book suffers from poor editing, including spelling errors (eg, section for secretion) and awkward syntax. While the authors seemed determined to present a balanced presentation of the vexing role of antipsychotics in the development of the metabolic syndrome, I sensed what may be a mild bias in favor of deemphasizing the role of the atypical agents. Given the controversy in this area and the intense publicity surrounding lawsuits filed against several companies over the alleged suppression of data on the metabolic adverse effects of atypicals, it is surprising that the editors chose a scientist from Eli Lilly to author the chapter on glucose abnormalities in major psychiatric disorders. In addition, more effort could have been directed toward the integration of often contradictory evidence regarding causality.
Reviewer's Summary: Even with the limitations just mentioned, I found this volume to be informative and helpful. Recent studies have continued to show that, with regard to the metabolic syndrome, psychiatric patients are badly underscreened, underdiagnosed, and undertreated. I intend to use data from this volume in a lecture series on clinical neuroscience. However, despite the editors' goals, I doubt that experienced bench scientists in immunology or endocrinology will find anything particularly new or exciting in this volume, unless they are interested in redirecting their work toward psychiatric disorders.
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