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

Abstract

Metabolic-endocrine disorders frequently co-occur with psychiatric and behavioural disturbances that are clinically consequential yet often under-recognised when care is organised around single-disease targets. In this narrative review, we synthesise evidence across major metabolic-endocrine conditions to propose a closed-loop framework in which immunometabolic stress (low-grade inflammation, insulin resistance, and metabolic toxicity) initiates or amplifies central symptom burden, while neuroendocrine axes and the gut-brain-metabolic interface act as bidirectional bridge modules that embed peripheral dysregulation into sleep disturbance, affective symptoms, appetite dysregulation, and cognitive inefficiency. These downstream changes are not merely comorbid “outcomes”; through impaired executive control and altered reward processing they erode behavioural feasibility, leading to inactivity, emotionally driven eating, reduced adherence, and disrupted follow-up, thereby reinforcing metabolic deterioration and sustaining relapse-prone trajectories. Within this systems view, traditional Chinese medicine offers a pragmatic, potentially complementary approach when positioned as adjunctive, module-targeted care rather than as a parallel diagnostic paradigm. We frame traditional Chinese medicine patterns as clinically useful phenotypic stratifiers that integrate symptom clusters relevant to sleep-stress regulation, eating behaviour, fatigue, and function, and we appraise clinical evidence using a matrix that prioritises dual-endpoint capture (metabolic and mental health/sleep/function outcomes), population relevance, and methodological transparency. Current evidence suggests potential benefit across modalities, including Chinese herbal medicine, acupuncture/electroacupuncture, and mind-body practices, but remains constrained by inconsistent dual-endpoint measurement, limited mediator capture, heterogeneous intervention protocols, and insufficient safety and interaction monitoring in polypharmacy-prone populations. We therefore propose an integrative care pathway that operationalises minimal screening, risk stratification, module-based intervention sequencing, and iterative dual-endpoint follow-up, alongside minimum methodological standards for future trials. Finally, we outline a precision and digital research agenda that leverages clinically feasible phenotyping and longitudinal monitoring of key mediators (sleep regularity, activity, autonomic markers, eating behaviour, and care persistence) to test mechanism, personalise sequencing, and strengthen real-world implementability.

Keywords: Metabolic-psychiatric comorbidity; Insulin resistance; Gut-brain-metabolic axis; Traditional Chinese medicine; Integrated care pathway

Core Tip: Endocrine-psychiatric comorbidity in metabolic disorders is conceptualised as a bidirectional, self-reinforcing state in which sleep and behavioural feasibility are clinically actionable leverage points that can shape metabolic trajectories. Traditional Chinese medicine is framed as adjunctive, module-targeted care, with pattern phenotyping used pragmatically for stratification rather than as a parallel diagnostic system. Credible integration requires paired metabolic and mental health endpoints, mediator tracking, and structured safety monitoring within an iterative care pathway.