The Thrifty Psychiatric Phenotype
The Thrifty Psychiatric Phenotype
The Thrifty Psychiatric Phenotype
2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
ACTA PSYCHIATRICA SCANDINAVICA
Editorial comment
Editorial comment
often shows itself in families where insanity prevails. Since Maudsley, several other contemporary
authors (12) delved deeper into the association with
diverse methodological diculties till the appearance of the studies in nave rst episode psychosis,
which avoided the confounding factor of pharmacological treatment. Those studies described abnormal glucose metabolism (higher fasting glucose
values and an insulin resistant state) (13); however,
higher cortisol values might have biased the results.
Nevertheless, the physiological challenge of an oral
glucose tolerance test did conrm the underlying
glucose disturbances (14), suggesting an abnormal
glucose homeostasis in individuals quite young to
be aected by regular risk factors associated with
mental health (unhealthy habits, obesity, and sedentary lifestyle) (15).
Patients with major aective disorders have
repeatedly been associated with obstetric diculties, specially stressful events during the second
and third trimester (7). Some data even suggest
that an earlier onset of aective disorder is directly
associated with obstetric abnormalities (16). A
review of obstetric complications in bipolar disorder did not nd any robust conclusion (17); however, methodological inadequacies might have
biased the conclusions; irrespective a critical review
of those studies does suggest an unexpected relationship with bipolar disorder.
Depression will be the second contributor to the
global burden of disease by 2020 according to the
World Health Organization, due not only to psychiatric disability but also to the associated comorbidity with physical diseases (18). As early as the
17th century, Thomas Willis, the physician who
described glycosuria as a sign of diabetes, stated
that it was caused by sadness or long sorrow and
other depressions (19). Later, epidemiological
studies conrmed the relationship between T2DM
and major depression disorder, even suggesting a
directionality from depression toward the onset of
T2DM (20) in young patients. Studies in nave
population aected from major depression disorder have shown several metabolic disturbances,
including an abnormal glucose metabolism state
(21).
The interest of research with respect to CVD,
T2DM, and metabolic disturbances in manicdepressive illness began with a seminal study by
Derby in 1933 (22). Increased morbidity and
mortality in bipolar disorder has been justied
mainly due to an increase ratio of medical-related
pathologies (18). In between those, glycemic
abnormalities are a consistent nding, recalling
pre-antipsychotic studies that highlighted an unexpected relationship between manic-depressive
19
Editorial comment
Eli Lilly, Pzer, Synthelab, Glaxo Smith Kline and AstraZeneca. Dr. Kirkpatrick received consulting fees from Roche,
Genentech, and he has nancial relationship with Prophase,
Inc.
C. Garcia-Rizo1,2,
E. Fernandez-Egea
, M. Bernardo1,2,5
and B. Kirkpatrick6
1
Barcelona Clinic Schizophrenia Unit, Neuroscience
Institute, University of Barcelona, Barcelona,
2
CIBERSAM, Madrid, Spain, 3Department of
Psychiatry, Addenbrooke0 s Hospital, University of
Cambridge, Cambridge, UK,
4
Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, UK, 5Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS),
Barcelona, Spain and 6Department of Psychiatry
and Behavioral Sciences, University of Nevada
School of Medicine, Reno, NV, USA
E-mail: cgarcia3@clinic.ub.es
2,3,4
References
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Press, 2006.
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Br Med Bull 2001;60:520.
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195.
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