Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode introduces the field of metabolic psychiatry, with a focus on patients with severe mental illness and metabolic syndrome. Our guest is Dr. Cindy Calkin, an Associate Professor in the Department of Psychiatry and Department of Neuroscience at Dalhousie University in Nova Scotia. Dr. Calkin has been a pioneer in the field of metabolic and neuroendocrine disorders in patients with bipolar disorder. Her research interests include examining the effects of obesity, insulin resistance and type II diabetes on the clinical course and outcomes in bipolar disorder.

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to… 

1. Describe the burden of metabolic syndrome in the population with severe mental illnesses

2. Explain reasons for the comorbidity between metabolic syndrome and severe mental illness

3. Identify biopsychosocial strategies to prevent or treat metabolic conditions in this population

Guest: Dr. Cindy Calkin

Hosts: Angad Singh, Gaurav Sharma, and Sara Abrahamson

Audio editing by: Gaurav Sharma

Show notes by: Sara Abrahamson & Gaurav Sharma 

Conflicts of interest: Neither our guest nor hosts for this episode have declared any conflicts of interest related to this topic.

Interview content:

• 0:00 - Introduction

• 00:54 - Learning objectives

• 01:37 - Dr. Calkin’s career trajectory

• 9:45 - Describing the burden of metabolic syndrome in severe mental illness

• 14:16 - What is the relationship between metabolic syndrome and severe mental illness

• 25:23 - Why is metabolic syndrome underdiagnosed in severe mental illness

• 27:56 - How to measure and monitor insulin resistance in clinical practice

• 32:44 - How stigma impacts treatment of metabolic syndrome in the mentally ill

• 34:02 - Lifestyle interventions for metabolic syndrome in the mentally ill

• 37:06 - Medication interventions for metabolic syndrome in the mentally ill

• 39:44 - Directions for future research in the metabolic psychiatry

• 41:48 - Episode summary

References:

• Bai, Y.-M., Li, C.-T., Tsai, S.-J., Tu, P.-C., Chen, M.-H., & Su, T.-P. (2016). Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder. BMC Psychiatry, 16(1), 448–448. https://doi.org/10.1186/s12888-016-1143-8

• Calkin, C., Kamintsky, L., & Friedman, A. (2022). Reversal of insulin resistance is associated with repair of blood-brain barrier dysfunction and remission in a patient with treatment-resistant bipolar depression. Bipolar Disorders, 24(5), 553-555. https://doi.org/10.1111/bdi.13199

• Calkin, C. V., Ruzickova, M., Uher, R., Hajek, T., Slaney, C. M., Garnham, J. S., ... & Alda, M. (2015). Insulin resistance and outcome in bipolar disorder. The British Journal of Psychiatry, 206(1), 52-57. https://doi.org/10.1192/bjp.bp.114.152850

• Giménez-Palomo, A., Gomes-da-Costa, S., Dodd, S., Pachiarotti, I., Verdolini, N., Vieta, E., & Berk, M. (2022). Does metabolic syndrome or its component factors alter the course of bipolar disorder? A systematic review. Neuroscience and Biobehavioral Reviews, 132, 142–153. https://doi.org/10.1016/j.neubiorev.2021.11.026

• Ho, C. S., Zhang, M. W., Mak, A., & Ho, R. C. (2014). Metabolic syndrome in psychiatry: advances in understanding and management. Advances in psychiatric treatment, 20(2), 101-112. https://doi.org/10.1192/apt.bp.113.011619

• Leboyer, M., Godin, O., Llorca, P. M., Aubin, V., Bellivier, F., Belzeaux, R., Courtet, P., Costagliola, D., Dubertret, C., M’Bailara, K., Haffen, E., Henry, C., Laouamri, H., Passerieux, C., Pelletier, A., Polosan, M., Roux, P., Schwan, R., Samalin, L., … Etain, B. (2022). Key findings on bipolar disorders from the longitudinal FondaMental Advanced Center of Expertise-Bipolar Disorder (FACE-BD) cohort. Journal of Affective Disorders, 307, 149–156. https://doi.org/10.1016/j.jad.2022.03.053

• Stogios, N., Humber, B., Agarwal, S. M., & Hahn, M. (2023). Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Current Psychiatry Reports, 25(11), 707-721. https://doi.org/10.1007/s11920-023-01458-0

• Vancampfort, D., Vansteelandt, K., Correll, C. U., Mitchell, A. J., De Herdt, A., Sienaert, P., Probst, M., & De Hert, M. (2013). Metabolic Syndrome and Metabolic Abnormalities in Bipolar Disorder: A Meta-Analysis of Prevalence Rates and Moderators. The American Journal of Psychiatry, 170(3), 265–274. https://doi.org/10.1176/appi.ajp.2012.12050620

• Ventriglio, A., Gentile, A., Stella, E., & Bellomo, A. (2015). Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management. Frontiers in Neuroscience, 9, 297–297. https://doi.org/10.3389/fnins.2015.00297

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