2023-05-30 09:52:05
Alterations were evident in multiple organ systems in people with neuropsychiatric disorders
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Key points Ask Do specific organ systems manifest ill health in individuals with common neuropsychiatric disorders? Findings This population-based, multicenter cohort study that included 85,748 adults with neuropsychiatric disorders and 87,420 healthy control individuals found that poor bodily health, particularly of the metabolic, hepatic and immune systems, was a more marked manifestation of mental illness than brain changes. However, neuroimaging phenotypes allowed differentiation between different neuropsychiatric diagnoses. Meaning Treatment of severe neuropsychiatric disorders must recognize the importance of poor physical health and aim at restoring brain and body function. |
Introduction
Mental illness is associated with higher rates of chronic physical illness, including coronary heart disease, obesity, and diabetes compared with the general population. This contributes substantially to the global health and economic burden due to increased morbidity, disability and mortality. However, in psychiatric care and services, physical health has been neglected and inadequately managed for decades.
Despite increased awareness of physical health in psychiatry, recognizing and treating chronic physical illness remains a challenge. It is likely that underestimate the poor physical health of patients due to existing disparities in care for people with mental illness, such as lack of access to adequate primary care, overshadowing of diagnosis, and difficulties in recognizing and reporting medical problems for some patients. Therefore, more work is needed to understand the associations between mental and physical comorbidities, which may facilitate holistic and integrated care in psychiatry.
Most meta-research has focused on cardiovascular and metabolic comorbidities in psychiatry. While infectious and immune-related comorbidities have also been investigated, the chronic disease burden of common diseases affecting other body systems is rarely explored. The association between brain and body health, as well as associated disease risk and physical multimorbidity across all body systems, therefore remain poorly characterized.
We systematically investigate the health of the brain and body in common neuropsychiatric conditions (ie, schizophrenia, bipolar disorder, depression, and generalized anxiety disorder). Using brain imaging, physiological measures, and blood- and urine-based markers acquired in more than 100.000 personas, we established composite organ health scores for brains and body systems. We calculated age- and sex-specific normative reference ranges for each organ health score based on healthy comparison individuals and quantified the extent to which individuals with the above conditions deviated from established normative ranges. This allowed us to develop multi-organ health profiles for each neuropsychiatric condition and to estimate the relative effect of these profiles on each individual’s bodily systems and physical health.
Importance
Physical health and chronic medical comorbidities are underestimated, inadequately treated, and often overlooked in psychiatry. A multi-organ and systemic characterization of brain-body health in neuropsychiatric disorders may allow systematic assessment of brain-body health status in patients and potentially identify new therapeutic targets.
Aim
Assess the health status of the brain and 7 body systems in common neuropsychiatric disorders.
Design, setting and participants
Brain imaging phenotypes, physiological measures, and blood- and urine-based markers were harmonized across multiple population-based neuroimaging biobanks in the US, UK, and Australia, including the Biobank from United Kingdom; Australian Schizophrenia Research Bank; imaging study, biomarkers and Australian lifestyle on ageing; Alzheimer’s Disease Neuroimaging Initiative; Prospective Imaging Study of Aging; Human-Young Adult Connectome Project; and the Human Connectome–Aging Project.
Cross-sectional data acquired between March 2006 and December 2020 were used to study organ health. Data were analyzed from October 18, 2021 to July 21, 2022. Adults 18 to 95 years of age with a lifetime diagnosis of 1 or more common neuropsychiatric disorders, including schizophrenia, bipolar disorder, depression, mental disorder, generalized anxiety and a healthy comparison group were included.
Main results and measures
Deviations from normative reference ranges for composite health scores that index the health and function of the brain and 7 body systems. Secondary outcomes included the accuracy of classification of diagnoses (disease vs. control) and the differentiation between diagnoses (disease vs. disease), measured by area under the receiver operating characteristic curve (AUC).
Results
This study included 85,748 participants with preselected neuropsychiatric disorders (36,324 men) and 87,420 healthy controls (40,560 men). Body health, especially the scores that index the metabolic, liver and immune healthdeviated from the normative reference ranges for the 4 neuropsychiatric disorders studied.
The poor bodily health was a more pronounced disease manifestation compared with brain changes in schizophrenia (AUC for body = 0.81 [IC del 95 %, 0,79-0,82]; AUC for brain = 0.79 [IC del 95 %, 0,79-0,79]), bipolar disorder (AUC for body = 0.67 [IC del 95 %, 0,67-0,68]; AUC for brain = 0.58 [IC del 95 %, 0,57-0,58]), depression (AUC for body = 0.67 [IC del 95 %, 0,67-0,68]; AUC for brain = 0.58 [95 % IC, 0,58-0,58]) and anxiety (AUC for body = 0.63 [95 % IC, 0,63-0,63]; AUC for brain = 0.57 [95 % IC, 0,57-0,58]).
However, 60]and mean AUC for brain = 0.65 [IC del 95 %, 0,65-0,65]; depression-other: mean AUC for body = 0.61 [IC del 95 %, 0,60-0,63] and mean AUC for brain = 0.65 [IC del 95 %, 0,65-0,66]; anxiety-other: mean AUC for body = 0.63 [IC del 95 %, 0,62-0,63] and mean AUC for brain = 0.66 [IC del 95 %, 0,65-0,66]. 60]and mean AUC for brain = 0.65 [IC del 95 %, 0,65-0,65]; depression-other: mean AUC for body = 0.61 [IC del 95 %, 0,60-0,63] and mean AUC for brain = 0.65 [IC del 95 %, 0,65-0,66]; anxiety-other: mean AUC for body = 0.63 [IC del 95 %, 0,62-0,63] and mean AUC for brain = 0.66 [IC del 95 %, 0,65-0,66].
Figure: Normative models and organ health scores for the brain and 7 body systems across adult life, using multimodal brain imaging, blood, urine, and acquired physiologic markers in more than 100,000 people.
Conclusions and relevance
In this cross-sectional study, neuropsychiatric disorders shared a substantial and largely overlapping footprint of poor bodily health. Routine monitoring of bodily health and comprehensive physical and mental health care can help reduce the adverse effect of physical comorbidity on people with mental illness.
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