Metabolic syndrome and cardiovascular risk in patients with severe mental illness

Metabolic syndrome and cardiovascular risk in patients with severe mental illness

Michele Fiorani1 Orcid, Laura OrsoliniOrcid, Umberto VolpeOrcid, Virginio SalviOrcid

1 – Department of Experimental and Clinical Medicine (DIMSC), Polytechnic University of Marche, Ancona

Corresponding Author: Virginio Salvi

virginiosalvi@gmail.com


DOI: 10.53146/lriog1202157

Abstract

People with severe mental illness such as Schizophrenia, Bipolar Disorder and Schizoaffective Disorder have a significantly increased risk of developing alterations in glucose and lipid metabolism compared to the general population, leading to weight gain, dyslipidemia, insulin resistance and diabetes. As a result, they have a two-fold increased risk of morbidity and mortality for cardiovascular disease and a life expectancy reduced by 15 years compared to the general population. Metabolic Syndrome, a cluster of risk factors such as abdominal obesity, hyperglycemia, hypertension and dyslipidemia leading to cardiovascular morbidity and mortality, has been widely investigated in patients with SMI. Numerous studies have been carried out worldwide, reporting a 58% higher risk in patients with SMI compared to the general population. The increased risk is explained by several factors more prevalent in people with SMI, such as the adoption of unhealthy lifestyles, some biological common grounds between mental and metabolic conditions, and, eventually, the use of psychopharmacological medications such as several antipsychotics, mood stabilizers and antidepressants. In this paper we will review the risk of metabolic syndrome in patients with SMI. Finally, given the mounting evidence of a specific risk, the issue of metabolic syndrome in women with SMI and the impact of related factors will also be discussed.

Keywords: severe mental illness; metabolic syndrome; cardiovascular risk; gender differences.


Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283


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Abnormal pap smear and negative colposcopy: how to avoid over/underdiagnosis and over/under treatments

Abnormal pap smear and negative colposcopy: how to avoid over/underdiagnosis and over/under treatments

Francesco SopracordevoleOrcid, Mariasole FicheraOrcid

1 – Complex organizational structure of Oncological Gynecology, Oncological Reference Center of Aviano – IRCCS – National Cancer Institute, Aviano

Corresponding Author: Francesco Sopracordevole

fsopracordevole@cro.it


DOI: 10.53146/lriog1202155

Abstract

Satisfactory and negative colposcopy with abnormal pap smear poses problems of diagnostic accuracy and subsequent diagnostic-therapeutic management, to avoid both diagnostic delays and overtreatments. The purpose of this work is to provide information on the diagnostic-therapeutic management for these cases in the context of the cost-benefit balaratio for the patient.
The most significant papers in the international literature on the subject of negative colposcopy and the use of random cervical biopsies in these cases were reviewed. The current SICPCV 2019 recommendations were considered. The risk factors for invasive neoplasia were considered: the cyto- logy for referral to colposcopy, the persistence of the cytological lesion, the characteristics of the woman (fertile age, menopausal status).
In women with negative colposcopy and ASC-US / LSIL pap smear, follow-up with excision in case of persistent cytological alteration at 24 months is indicated. In case of AGC, the endocervix and, if necessary, the endometrium should be evaluated. Immediate diagnostic excision is indicated for AGC-H positive lesion. This may be the first choice in postmenopau- sal women with ASC-H / HSIL, in other cases excision is indicated in case of persistence of the cytological abnormality. Currently, there is no evidence accepted by the Guidelines / Recommendations of Italian scientific societies to support the execution of random biopsies in case of abnormal pap smear and negative colposcopy.
The diagnostic-therapeutic management in case of an abnormal pap smear and negative colposcopy is well defined and reduces the risks of over/underdiagnosis and over/under-treatment for the woman, as well as providing reassurance for the action of the gynecologist. The whole process, and above all the diagnosis of negative colposcopy, must be reliable. The guidelines/recommendations of scientific societies remain the point of reference for safe therapeutic-diagnostic management.

Keywords: negative colposcopy; pap smear; random cervical biopsy; uterine cervix; prevention.


Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283


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Anorexia nervosa: hypothalamic amenorrhea and bone metabolism

 Anorexia nervosa: hypothalamic amenorrhea and bone metabolism

Daniela Laudisio1,2 Orcid, Chiara Graziadio1,2 Orcid, Renata Simona AuriemmaOrcid, Emanuela FiliceOrcid, Silvia Savastano1,2 Orcid, Annamaria Colao1,2,3 Orcid

1 – Department of Clinical Medicine and Surgery, Endocrinology Unit, University “Federico II” of Naples, Naples, Italy.

2 – Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Section of Endocrinology, “Federico II” University of Naples, Naples, Italy

3 – Unesco Chair “Health Education and Sustainable Development”, University “Federico II” of Naples, Naples, Italy

Corresponding Author: Daniela Laudisio

daniela.laudisio@libero.it


DOI: 10.53146/lriog1202154

Abstract

Anorexia nervosa is a psychiatric disorder, predominantly affecting adolescent women, and is characterized by a low body weight following a state of self-induced starvation. This disorder is associated with hormonal adaptations that consume energy expenditure to a minimum in a context of low nutrient intake. These adaptations include: functional hypothalamic amenorrhea, resistance to growth hormone, low concentrations of insulin- like growth factor, low concentrations of leptin and hypercortisolemia. Although, these adaptations may be useful for the short-term survival, often, they contribute to morbidity associated with this disorder, and in particular bone loss, which affects 85% of women with anorexia nervosa. In fact, this category of patients, often demonstrates low bone mineral density and high fractures risk, with low body weight and low gonads being the strongest predictors of observed bone mineral deficiency and fractures risk. Weight restoration and the resumption of menstrual function have the strongest impact on increasing bone mineral density. Other treatment options include bisphosphonates and teriparatide, supported by small clinical trials.

Keywords: nervous anorexia; functional hypothalamic amenorrhea; osteoporosis; bone mineral density; risk of fractures.


Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283


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Hypovitaminosis D and metabolic syndrome

Hypovitaminosis D and metabolic syndrome

Martina Leoni1* Orcid, Marco Infante 1,2,3,4,* Orcid, Raffaele Infante 4 Orcid, Massimiliano Caprio 5,6Orcid, Andrea Fabbri1 – Orcid

1 – Transmural Complex Organizational Unit of Endocrinology & Diabetes Research Institute Federation (DRIF), Department of Systems Medicine, CTO A. Alesini & S.Eugenio Hospitals, Local Health Center Roma 2, University of Rome Tor Vergata (Rome, Italy)

2 – UniCamillus, Saint Camillus International University of Health Sciences (Roma, Italia)

3 – Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN) (Roma, Italia)

4 – Cardio Endocrino Metabolica (CEM) – Endocrine and Cardiometabolic Center (Salerno, Italia)

5 – Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University of Rome (Rome, Italy)

6 – Cardiovascular Endocrinology Laboratory, Scientific Institute for Research, Hospitalization and Healthcare, San Raffaele Rome (Rome, Italy)

*Martina Leoni e Marco Infante hanno contribuito in egual misura alla stesura del presente articolo.

Autore di riferimento: Marco Infante

marco.infante@unicamillus.org


DOI: 10.53146/lriog1202162

Abstract

Metabolic syndrome is a complex disorder characterized by the co-occurrence of several known cardiovascular risk factors, including obesity, insulin resistance, atherogenic dyslipidemia and hypertension. As such, metabolic syndrome is associated with an increased risk of cardiovascular disease and type 2 diabetes mellitus. Of note, metabolic syndrome is defined by the presence of at least three of the following conditions: abdominal obesity (or central obesity), high blood pressure (≥130/≥85 mmHg), abnormal fasting plasma glucose (≥100 mg/dL), elevated serum triglycerides (≥150 mg/dL) and low high-density lipoprotein (HDL)-cholesterol level (<40 mg/dL in men, <50 mg/dL in women). Over the last years, the global prevalence of metabolic syndrome has progressively increased as a consequence of the increasing rates of overweight/obesity, population ageing, and lifestyle changes favoring sedentary behaviors, physical inactivity and unhealthy dietary habits. On the other hand, the global prevalence of vitamin D deficiency has concurrently increased. To date, vitamin D deficiency is regarded as a global pandemic afflicting more than one billion individuals across all age groups worldwide. Since growing evidence suggests that vitamin D exerts several pleiotropic extraskeletal actions beyond its well-established role in the regulation of bone homeostasis, researchers have proposed that vitamin D deficiency may be involved in the pathophysiology of metabolic syndrome. Therefore, this brief Report article aims to summarize the current scientific evidence regarding the possible causal relationship between vitamin D deficiency and metabolic syndrome, as well as the potential favorable effects Keywords: metabolic syndrome; obesity; vitamin D deficiency; insulin resistance; type 2 diabetes mellitus; cardiometabolic risk.


Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283


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Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis

Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis

Alessandra Graziottin 1,2 Orcid, Elena Boero 1 Orcid

1 – Alessandra Graziottin Foundation for the cure and care of pain in women NPO

2 – Center of Gynecology and Medical Sexology, San Raffaele Resnati Hospital, Milan, Italy

Corresponding Author: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog1202161

Abstract

Sexual pain at intercourse, or dyspareunia, is a common symptom affecting up to 1 in 5 women. Despite its high prevalence, sexual pain is still underdiagnosed. When recognized it is poorly characterized in its etiology and consequently undertreated by clinicians, especially when they are not trained in sexual medicine. Sexual pain always has precise biological causes and is often comorbid with other gynecological, pelvic, muscular, urinary, and/ or intestinal pathologies. Correct diagnosis and treatment of sexual pain require collecting a detailed clinical history aimed at identifying the most relevant predisposing, precipitating, and maintenance factors. The goal of the work is to provide the clinician with a questionnaire to make the anamnesis of sexual pain “physician-friendly”, and facilitate the in-depth diagnosis of sexual pain. The clinical reasoning is carefully discussed as well, to guide the reading of the symptoms and signs of the pathologies potentially responsible for sexual pain to identify a tailored multimodal therapy.

Keywords: sexual pain; superficial dyspareunia; deep dyspareunia; clinical history; vulvar pain; endometriosis.


Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283


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Primary amenorrheas: normogonadotropic, hypogonadotropic, hypergonadotropic

Primary amenorrheas: normogonadotropic, hypogonadotropic, hypergonadotropic

Vincenzina Bruni 1 Orcid, Metella Dei Orcid

1 – University of Florence

2 – Endocrinologist gynecologist. Freelancer

Corresponding Author: Vincenzina Bruni

vbruni@unifi.it


DOI: 10.53146/lriog1202160

Abstract

Menarche is a critical cue of female sexual and reproductive health. Therefore, the absence of menses at appropriate age needs a competent evaluation. The article outlines the various pathogenesis behind the symptom of primary amenorrhea, starting from situations not related to endocrine disorders such as outflow tract obstruction or uterine underdevelopment. The diagnostic assessment in situations of hypogonadism is often a challenge for the clinician and may require successive rounds of investigation, especially in the differential diagnosis between pubertal delay and hypogonadotropic hypogonadism. An impaired development of the gonads is, for females, one of the leading causes of primary amenorrhea: understanding the genetics behind gonadal dysgenesis improves the ongoing care of the girl and the prediction of associated medical problems. Therapeutic options for these different situations will be the topic of a following review.

Keywords: primary amenorrhoea; constitutional pubertal delay, hypogonadotropic hypogonadism; functional hypogonadism; premature ovarian deficiency.


Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283


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