Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: Systematic review and metaanalysis

Department of Mental Health Sciences, (Royal Free Campus), University College London Medical School, Rowland Hill Street, London, NW3 2PF, UK.
BMC Psychiatry (Impact Factor: 2.21). 10/2008; 8(1):84. DOI: 10.1186/1471-244X-8-84
Source: PubMed

ABSTRACT Severe mental illnesses (SMI) may be independently associated with cardiovascular risk factors and the metabolic syndrome. We aimed to systematically assess studies that compared diabetes, dyslipidaemia, hypertension and metabolic syndrome in people with and without SMI.
We systematically searched MEDLINE, EMBASE, CINAHL & PsycINFO. We hand searched reference lists of key articles. We employed three search main themes: SMI, cardiovascular disease, and each cardiovascular risk factor. We selected cross-sectional, case control, cohort or intervention studies comparing one or more risk factor in both SMI and a reference group. We excluded studies without any reference group. We extracted data on: study design, cardiovascular risk factor(s) and their measurement, diagnosis of SMI, study setting, sampling method, nature of comparison group and data on key risk factors.
Of 14592 citations, 134 papers met criteria and 36 were finally included. 26 reported on diabetes, 12 hypertension, 11 dyslipidaemia, and 4 metabolic syndrome. Most studies were cross sectional, small and several lacked comparison data suitable for extraction. Meta-analysis was possible for diabetes, cholesterol and hypertension; revealing a pooled risk ratio of 1.70 (1.21 to 2.37) for diabetes and 1.11 (0.91 to 1.35) of hypertension. Restricting SMI to schizophreniform illnesses yielded a pooled risk ratio for diabetes of 1.87 (1.68 to 2.09). Total cholesterol was not higher in people with SMI (Standardized Mean Difference -0.10 (-0.55 to 0.36)) and there were inconsistent data on HDL, LDL and triglycerides with some, but not all, reporting lower levels of HDL cholesterol and raised triglyceride levels. Metabolic syndrome appeared more common in SMI.
Diabetes (but not hypertension) is more common in SMI. Data on other risk factors were limited by poor quality or inconsistent research findings, but a small number of studies show greater prevalence of the metabolic syndrome in SMI.

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Available from: David Osborn, Jul 24, 2014
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    • "People with severe mental illness (SMI) have high rates of physical co-morbidity [1]. "
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    ABSTRACT: Standardized mortality ratios are twice the population average in the year following a mental health admission, yet there is a relative paucity of research on uptake of general medical care in psychiatric inpatients. A retrospective database analysis was performed to ascertain the frequency of acute medical care usage by psychiatric inpatients. Data were gathered through a static linkage between anonymized clinical records in a large UK mental health provider and the national hospital activity database (Hospital Episode Statistics) over 1year from 2010 to 2011. Over the year, 10.4% of the 8023 psychiatric admission episodes included at least one night in a general hospital during that psychiatric inpatient stay, while 12.0% of psychiatry admission episodes entailed an emergency department (ED) visit. Over the course of the full year, of the 4674 people admitted to the mental health provider at least once, 16.0% were admitted to a general hospital while registered as a mental health inpatient and 18.0% were seen in the ED. Patients were simultaneously registered as occupying beds in both general and psychiatric hospitals for a total of 5163 bed days at a cost of £2.4 million over the year. This large population-based linkage study indicates a high rate of general hospital utilization by psychiatric inpatients in an independent mental health provider. The need for combined, flexible and practical approaches to the medical care of psychiatric inpatients is highlighted to reduce unplanned care and provide treatment in the site best suited to the patient's needs. Copyright © 2015. Published by Elsevier Inc.
    General hospital psychiatry 07/2015; DOI:10.1016/j.genhosppsych.2015.07.006 · 2.61 Impact Factor
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    • "Patients have decreased rates of rheumatoid arthritis, malignant melanoma, prostate cancer and colorectal cancer and increased risk of cardiovascular disease, diabetes, metabolic syndrome, osteoporosis, post-surgery mortality, respiratory failure, deep venous thrombosis, pulmonary embolism and sepsis (Leucht et al. 2007b; Catts et al. 2008; Copeland et al. 2008; Osborn et al. 2008; Meyer & Stahl, 2009; Oud & Meyboom-De Jong, 2009). Patients also have increased risk of anxiety and personality disorders (Newton-Howes et al. 2008; Achim et al. 2011) Patients have increased exposure in utero to maternal herpes simplex virus, upper respiratory tract, genital or reproductive infections, and inflammatory cytokines TNF-α and IL-8 (Khandaker et al. 2013) Increased risk of violence in people with schizophrenia may be explained by co-morbid substance use (Fazel et al. 2009) Patients report increased rates of criminal victimization (Maniglio, 2009) Longer duration of untreated psychosis is associated with the presence of obligatory dangerousness criterion for compulsory treatment (Large et al. 2008) Up to 80% of people following a first episode of psychosis have good or intermediate outcomes up to 3 years from onset (Menezes et al. 2006) Rates of recovery and remission increase over time, from around 13% of patients at 5 years to around 68% of patients by 32 years after first diagnosis (Leucht & Lasser, 2006) In people at ultra-high risk for psychosis, the transition to psychosis rate is approximately 18% after 6 months of follow-up, 22% after 1 year, 29% after 2 years, and 36% after 3 years, regardless of the psychometric instruments used to measure transition. "
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    ABSTRACT: Background. True findings about schizophrenia remain elusive; many findings are not replicated and conflicting results are common. Well-conducted systematic reviews have the ability to make robust, generalizable conclusions, with good meta-analyses potentially providing the closest estimate of the true effect size. In this paper, we undertake a systematic approach to synthesising the available evidence from well-conducted systematic reviews on schizophrenia. Method. Reviews were identified by searching Medline, EMBASE, CINAHL, Current Contents and PsycINFO. The decision to include or exclude reviews, data extraction and quality assessments were conducted in duplicate. Evidence was graded as high quality if reviews contained large samples and robust results; and as moderate quality if reviews contained imprecision, inconsistency, smaller samples or study designs that may be prone to bias. Results. High- and moderate-quality evidence shows that numerous psychosocial and biomedical treatments are effective. Patients have relatively poor cognitive functioning, and subtle, but diverse, structural brain alterations, altered electrophysiological functioning and sleep patterns, minor physical anomalies, neurological soft signs, and sensory alterations. There are markers of infection, inflammation or altered immunological parameters; and there is increased mortality from a range of causes. Risk for schizophrenia is increased with cannabis use, pregnancy and birth complications, prenatal exposure to Toxoplasma gondii, childhood central nervous system viral infections, childhood adversities, urbanicity and immigration (first and second generation), particularly in certain ethnic groups. Developmental motor delays and lower intelligence quotient in childhood and adolescence are apparent. Conclusions. We conclude that while our knowledge of schizophrenia is very substantial, our understanding of it remains limited.
    Psychological Medicine 02/2014; 44(16). DOI:10.1017/S0033291714000166 · 5.94 Impact Factor
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    • "Individuals with major psychotic and/or affective disorders (for example, schizophrenia, bipolar disorder or major depressive disorder) experience higher rates of comorbid physical health problems compared with the general population. Cardiovascular risk and metabolic risk are increased in individuals with schizophrenia [1-3] and depression [4,5]. Bipolar disorder has also been shown to be associated with metabolic syndrome [6,7]. "
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    ABSTRACT: Individuals with major psychotic and/or affective disorders are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous pharmacological and non-pharmacological interventions have been tested in inpatient and outpatient mental health settings to decrease these risk factors. This review focuses on primary care-based non-pharmacological (educational or behavioral) interventions to decrease metabolic syndrome risk factors in adults with major psychotic and/or affective disorders. The authors conducted database searches of PsychINFO, MEDLINE and the Cochrane Database of Systematic Reviews, as well as manual searches and gray literature searches to identify included studies. The authors were unable to identify any studies meeting a priori inclusion criteria because there were no primary care-based studies. This review was unable to demonstrate effectiveness of educational interventions in primary care. Interventions to decrease metabolic syndrome risk have been demonstrated to be effective in mental health and other outpatient settings. The prevalence of mental illness in primary care settings warrants similar interventions to improve health outcomes for this population.
    Systematic Reviews 12/2013; 2(1):116. DOI:10.1186/2046-4053-2-116
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