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

Figure 3 Conceptual framework of endocrine-psychiatric comorbidity in metabolic-endocrine disorders. Major metabolic-endocrine conditions are linked to psychiatric and behavioral phenotypes through bidirectional pathways. Metabolic disease may worsen mental health via metabolic inflammation, endocrine-autonomic dysregulation (hypothalamic-pituitary-adrenal/sympathetic nervous system), and gut-brain signaling, whereas psychiatric illness and its management may aggravate metabolic status through behavioral changes, chronic stress biology, and psychotropic metabolic liability. These overlapping patterns (disease-driven, behavior-driven, and treatment-emergent) contribute to poorer metabolic control, higher cardiometabolic risk, reduced adherence, and lower quality of life, underscoring unmet needs for integrated screening and dual-endpoint interventions targeting both metabolic and mental health outcomes. PCOS: Polycystic ovary syndrome; HPA: Hypothalamic-pituitary-adrenal; SNS: Sympathetic nervous system; OSA: Obstructive sleep apnea; MAFLD: Metabolic dysfunction-associated fatty liver disease.