Skip to main content

Table 1 Causes of Fatty liver disease related and unrelated to patients with psychiatric disorders [10, 11]

From: Non-alcoholic fatty liver disease (NAFLD) as a neglected metabolic companion of psychiatric disorders: common pathways and future approaches

  Related to psychiatric disorder Non-related to psychiatric disorders
Nutritional Starvation
Protein-calorie malnutrition
Rapid weight loss
Total parenteral nutrition
Gastrointestinal surgery for obesity
Drug-induced Valproic acid
Antiviral agents: Zidovudine, Didanosine, Fialuridine
Synthetic estrogens
Calcium-channel blockers
Perhexiline maleate
Metabolic or genetic   Lipodystrophy
Weber–Christian disease
Wolman’s disease
Cholesterol ester or Glycogen storage disease
Acute fatty liver of pregnancy
Lysosomal acid lipase deficiency
Familial combined hyperlipidaemia
Wilson’s disease
Other§ Human immunodeficiency virus (HIV)
Hepatitis B (HBV) and C (HCV) virus
Environmental hepatotoxins: Phosphorus; Petrochemicals; Toxic mushrooms; Organic solvents
Inflammatory bowel disease
Small-bowel diverticulosis with bacterial overgrowth
Bacillus cereus toxins
Autoimmune hepatitis
  1. Decreased appetite, malnutrition, and weight loss are common features in many psychiatric disorders, ranging from eating disorders, loss of appetite, and secondary weight loss in depression or lack of nutrition in psychotic disorders due to paranoid delusions. Moreover, some patients with severe eating disorders or severe suicide attempts may require parenteral nutrition. Finally, the prevalence of obesity is higher in patients with psychiatric disorders than in the general population, with some requiring from bariatric surgery
  2. These agents produce fatty liver or liver inflammation. Valproic acid is a mood stabilizer commonly used in bipolar disorder. Cocaine is highly associated with psychiatric disorders such as drug use disorders, as well as affective, psychotic, or personality disorders. The use of glucocorticoids may sometimes induce manic or depressive states. Patients with psychiatric disorders have higher prevalence of HIV and require the use of antivirals for infection control. The association of fatty liver with amiodarone is strong, whereas its association with valproic acid or calcium-channel blockers is weak. Drug-induced fatty liver may have no sequelae (e.g., cases caused by glucocorticoids) or can result in cirrhosis (e.g., cases caused by methotrexate and amiodarone)
  3. §The prevalence of HIV, HCV, and HVB in patients with psychiatric disorders is higher than in the general population. Moreover, some suicidal attempts, although uncommon, may be due to environmental hepatotoxins, such as organic solvents