Endocrine psychiatric comorbidity in metabolic disorders: Integrative mechanisms and traditional Chinese medicine

Figure 2 Proposed integrative clinical pathway for endocrine-psychiatric comorbidity in metabolic-endocrine disorders. Patients undergo a minimal screening set (Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and Insomnia Severity Index/Pittsburgh Sleep Quality Index) followed by risk stratification to guide tiered, dual-endpoint intervention packages; traditional Chinese medicine pattern assessment and options are incorporated when appropriate with safety monitoring, and outcomes are reassessed using metabolic and mental health endpoints to iteratively adjust care intensity. PHQ-9: Patient Health Questionnaire 9; GAD-7: Generalized Anxiety Disorder 7; ISI: Insomnia Severity Index; PSQI: Pittsburgh Sleep Quality Index; T2DM: Type 2 diabetes mellitus; MAFLD: Metabolic dysfunction-associated fatty liver disease; PCOS: Polycystic ovary syndrome; TCM: Traditional Chinese medicine; HbA1C: Glycated hemoglobin; CRP: C-reactive protein; IL-6: Interleukin-6; HRV: Heart rate variability.