Many psychiatric patients may have abnormalities in liver function tests during drug therapy, such as a few dozen units of alanine aminotransferase (ALT) elevation. At this time, most patients will be worried about this: “taking drugs to eat the liver bad”, and think that this means that there is liver damage, the occurrence of “drug hepatitis”, will develop into “cirrhosis “They think that this means liver damage, drug-induced hepatitis, liver cirrhosis, liver cancer, and so on. These concerns reflect not only their pessimistic predictions about the future, i.e., negative cognitive patterns, but also their irrational assumptions of equating simple abnormalities in test values with impairment of liver function, liver damage, or even substantial, irreversible lesions of the liver. Here, I will sort out and explain the concept of “abnormal liver function” marked by elevated aminotransferase values, in the hope of alleviating some of the patients’ concerns. First of all, it is necessary to clarify the difference between “abnormal liver function” and “abnormal liver function” as reflected by elevated aminotransferase values in liver function tests. The so-called “liver function”, which is based on detecting the activity of certain liver cell enzymes in the blood, is an indirect means of understanding certain indicators that indirectly reflect the metabolic function of the liver in the era when there were no ultrasound, CT, or magnetic resonance imaging methods, so that medical practitioners could infer the degree of damage to the corresponding functions of the liver in patients with liver diseases. The degree of damage to the corresponding functions of the liver in patients with liver diseases. The result of this double indirectness of indirect means and indirect reflection is that most patients with liver disease have clear abnormalities of liver function, and some people without liver disease also have elevated values of individual indicators of this test. Therefore, to assume that there is liver disease or a true “liver abnormality” on the basis of an elevated aminotransferase value from this test is clearly unrealistic or an overestimation of the severity of the problem. This is especially true because most of the elevations in aminotransferases detected during psychiatric medication are only tens of units, which is a “mild elevation” and cannot be considered as a basis for “abnormal liver function”. Sometimes such elevations have no pathological significance at all: for example, a healthy person may have a mild elevation of aminotransferases after a strenuous exercise session, after being overworked, after eating greasy food before the blood draw, or after consuming alcohol. Secondly, it is important to clarify whether there is a direct causal relationship between “abnormal liver function tests” marked by elevated aminotransferase values and medication. The reason why psychiatric patients taking psychiatric drugs for a long period of time show abnormal liver function test results characterized by mild to moderate elevation of alanine aminotransferase (ALT) is not due to the drugs alone. As a general phenomenon, patients may experience fatigue, increased appetite and decreased physical activity as a side effect of the medication, or they may eat more and exercise less because of their childhood habits or symptoms of the disease, with a significant increase in obesity during the treatment period. At the same time, patients are often accompanied by lipid metabolism abnormalities such as elevated triglycerides and cholesterol, elevated LDL cholesterol, and decreased HDL cholesterol. If liver ultrasound is performed on patients at this time, they will also be found to have mild to moderate or even severe fatty liver. The liver function test abnormalities (mild to moderate elevation of aminotransferases) that accompany lipid metabolism abnormalities and fatty liver are also present in “normal” people who are not taking medication but who have fatty liver, and these markers return to normal when their fatty liver is cured. One of my graduate students did a study of psychiatric patients who had “abnormal liver function tests” while on medication. She found a positive correlation between elevated ALT values and increased body mass index (BMI) and waist-to-hip ratio (WHR), which are indicators of body weight, in 70 patients with elevated ALT values. After 4 weeks of treatment with standard doses of lipid-lowering drugs, these patients normalized their liver function test abnormalities, including elevated ALT values, while decreasing their body weight and improving their lipid profile. Moreover, the degree of ALT improvement in these patients treated with lipid-lowering drugs was similar to that in patients treated with hepatoprotective drugs. In my personal clinical practice, I have also found that patients with liver function abnormalities mainly characterized by elevated ALT values, after weight loss and lipid-lowering therapy, while the degree of obesity is reduced, the corresponding liver function test indicators are also restored to the normal range or tend to return to normal. Finally, it is also necessary to clarify the different pathological significance of the differences in the degree of transaminase elevation. In general, mild to moderate elevations of aminotransferases are of limited pathologic significance and should not be viewed with alarm. If the aminotransferase is outside the normal range, the first step is to have it reviewed at the earliest possible time. However, even if the results are still abnormal, the degree of transaminase (ALT) elevation should not be used to judge the condition, but should be combined with other indicators of liver function (such as serum bilirubin, cholinesterase, albumin, etc.) and ultrasound results of the liver, gallbladder and spleen to comprehensively determine the degree of liver damage. In particular, it is worth emphasizing that liver lesions also have many systemic symptoms and signs, such as anorexia, emaciation, abdominal distension, diarrhea, obvious weakness, as well as jaundice, hypoproteinemia, and so on, not only the value of aminotransferases is elevated. Therefore, psychiatric patients taking psychiatric drugs, if the “liver function” is abnormal in the hospital checkup program, do not be overly nervous, and do not be anxious to attribute the abnormality to psychiatric drugs, but to rationally look at and understand, and let the doctor to solve the problem. Attached is a list of criteria for determining elevated alanine aminotransferase (ALT): 1. Less than 120 IU/L is considered mild transaminase elevation; 2. Between 120-400 IU/L is considered moderate transaminase elevation; 3. Greater than 400 IU/L is considered severe transaminase elevation.