Psychosocial and clinical characteristics of depressive patients with the diagnosis of metabolic syndrome

IntroductionMore severe mental illnesses, like depression, are connected with various cardiovasCular risk factors, like hypertension, obesity, atherogenic dyslipidemia, hyperglycemia, smoking and alcohol and other psychoactive substances abuse. Patients suffering from the depressive disorder display alterations of circadian rhythm, sleep disturbances, changes of autonomic nervous system, hypothalamus-hypophysis-adrenal gland axis (HHN) hyperactivity and changes of immunologic system. On the other hand, the somatic diseases, like obesity, hyperlipidemia, hypertension and diabetes mellitus type II are lately ever more often accepted as significant comorbid states in patients with more severe mental diseases. There is ever more data showing that the severe mental illnesses also affect the somatic health and only lately, these states are evaluated in the context of metabolic syndrome. Pathogenesis of metabolic syndrome, similar to pathogenesis of depression, is complex and insufficiently investigated. However, it is considered that the interactions of chronic stress, psychological trauma, hypercortisolism and disturbed immunologic functions contribute to the development of these disturbances [1-6].Metabolic syndrome (MS) is a complex multisystem disturbance, consisting of several components, namely: abdominal obesity, lipid metabolism dysfunction, hypertension and glucose metabolism dysfunction [7]. Besides that, the syndrome is connected with pro-inflammatory and pro-thrombotic state, resulting from the secretory activity of fat tissue, characterized by an increased level of inflammation mediators, endothelial dysfunction, hyperfibrinogenaemia, increased aggregation of thrombocytes, increased concentration of plasminogen activation inhibitors, increased levels of uric acid and microalbuminuria. MS represents the greatest risk for diabetes and cardiovascular diseases. MS was described in patients with polycystic ovaries syndrome, non-alcoholic steatosis of the liver, microalbuminuria and chronic renal failure [7-10].Depression is a complex disease, connected with alterations of sleep, appetite, body weight and level of physical activity, all of which can represent risk factors for the development of metabolic disturbances. In depressive patients, various physiological mechanisms can influence the development of metabolic syndrome, such as disturbed regulation of HHN axis and noradrenergic system, as well as various psycho-social factors, such as gender, age, smoking, stress levels, nutrition and level of physical activity [11-14]. It is possible that MS represents a connection between depression on one and KVB and diabetes on the other side. It is considered that chronic stress causes depression and consequently harmful lifestyle, which can lead to MS and consequently, development of KVB [15]. Disturbed regulation of HHN axis is typically connected to chronic stress and numerous studies had described such connection between depression and high levels of cortysole [16-18]. On the other hand, increased levels of cortysole are connected with components of metabolic syndrome, such as the abdominal obesity and glucose intolerance, so depression can indirectly influence the metabolism of glucose and the risk of diabetes development [19,20]. Besides that, psycho-social variables, such as depressive mood, can result in changes of levels of pro-inflammatory cytokines, which are also important components for the development of metabolic syndrome [21].Based on the research so far, we may say that the depressive patients show a greater incidence of cardiovascular diseases, hypertension and diabetes compared to the other psychiatric patients and the general population [22-39]. Symptoms of a depressive disturbance are frequently observed among the patients with MS and fatigue is a frequent symptom in states with a chronic activation of non-specific immunity, such as MS [3943].The aim of this study was to determine the psychosocial and clinical features of depressive patients diagnosed with MS. …