A reversible metabolic and endocrine subset in first-presentation psychosis: a testable hypothesis and screening protocol
OSF Preprint id: fep-metabolic-v0.9
A measurable minority of patients presenting for first-episode psychosis carry an identifiable metabolic or endocrine condition driving the psychotic syndrome rather than co-occurring with it. Antipsychotic-naïve patients exhibit elevated insulin resistance (HOMA-IR Hedges' g = 0.35) and impaired glucose tolerance (post-OGTT glucose g = 0.61) at psychiatric onset, while HbA1c is unaltered (g = −0.08; Pillinger et al., 2017) — the standard screening test misses episodic hypoglycemia and subclinical insulinoma drivers. We propose a prospective 1,250-patient multi-center screening trial combining continuous glucose monitoring (CGM), temporal-concordance lag analysis, and cause-directed treatment protocols.





