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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

Cocaine

Glucocorticoids

Antiviral agents: Zidovudine, Didanosine, Fialuridine

Synthetic estrogens

Aspirin

Calcium-channel blockers

Tamoxifen

Tetracycline

Amiodarone

Methotrexate

Perhexiline maleate

Metabolic or genetic

 

Lipodystrophy

Dysbetalipoproteinemia

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
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BMC Medicine

ISSN: 1741-7015

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