The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year

Department of Pharmacy, Division of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands.
Journal of Psychiatric Research (Impact Factor: 3.96). 04/2009; 43(13):1106-11. DOI: 10.1016/j.jpsychires.2009.03.002
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Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia.This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find variables to describe development and reversal of metabolic syndrome. This cohort study was conducted as part of a disease management program and patients were included if they had two complete assessments in a one year follow-up. We conducted two logistic regressions to find variables to describe the development of metabolic syndrome and the reversal of metabolic syndrome. At the time of the first assessment 35% (n=92) of the 260 included patients had metabolic syndrome. Within one year 21 patients developed metabolic syndrome and 30 patients had it reversed. This was an incidence of 13% (21/168) and a reversal of 33% (30/92). Smoking, family history of cardiovascular diseases, and duration of disease >6 years was associated with a higher risk of developing metabolic syndrome as well as abdominal obesity and dyslipidemia. Patients with abdominal obesity had a smaller chance of reversing metabolic syndrome. Other variables included in the logistic regression such as receiving cardiovascular/antidiabetic drug treatment or duration of disease >6 years did not alter the risk of reversing the metabolic syndrome. Our study showed that the natural course of metabolic syndrome is dynamic. A considerable number of patients developed or reversed the metabolic syndrome in one year follow-up.

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    • "Fourth, as individuals can enter and exit the definition of MetS in a given time period (e.g., one year) depending on changes in levels of its clinical components [80], there is a possibility that in assessing the incident MetS, the current study has missed participants who developed MetS and then reversed prior to their second clinic visit, particularly those with a long interval between the two visits (e.g., >five years). This shortcoming may have resulted in an underestimate (not an overestimate) of the true MetS incidence and strength of its relationships with area-level SEP characteristics. "
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    ABSTRACT: The evidence linking socioeconomic environments and metabolic syndrome (MetS) has primarily been based on cross-sectional studies. This study prospectively examined the relationships between area-level socioeconomic position (SEP) and the incidence of MetS. A prospective cohort study design was employed involving 1,877 men and women aged 18+ living in metropolitan Adelaide, Australia, all free of MetS at baseline. Area-level SEP measures, derived from Census data, included proportion of residents completing a university education, and median household weekly income. MetS, defined according to International Diabetes Federation, was ascertained after an average of 3.6 years follow up. Associations between each area-level SEP measure and incident MetS were examined by Poisson regression Generalised Estimating Equations models. Interaction between area- and individual-level SEP variables was also tested. A total of 156 men (18.7%) and 153 women (13.1%) developed MetS. Each percentage increase in the proportion of residents with a university education corresponded to a 2% lower risk of developing MetS (age and sex-adjusted incidence risk ratio (RR) = 0.98; 95% confidence interval (CI) =0.97-0.99). This association persisted after adjustment for individual-level income, education, and health behaviours. There was no significant association between area-level income and incident MetS overall. For the high income participants, however, a one standard deviation increase in median household weekly income was associated with a 29% higher risk of developing MetS (Adjusted RR = 1.29; 95%CI = 1.04-1.60) CONCLUSIONS: While area-level education was independently and inversely associated with the risk of developing MetS, the association between area-level income and the MetS incidence was modified by individual-level income.
    BMC Public Health 07/2013; 13(1):681. DOI:10.1186/1471-2458-13-681 · 2.26 Impact Factor
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    • "Since most patients with schizophrenia are not physically active, it is obvious that promotion of an active lifestyle is an important intervention in managing weight gain and metabolic disturbances in these patients (Faulkner et al., 2007). Implementation of exercise/physical activity programmes to the treatment of schizophrenia is important, because the course of metabolic syndrome is dynamic and a considerable number of schizophrenic patients may reverse the metabolic syndrome (Schorr et al., 2009). Furthermore, there is growing evidence demonstrating that reduced physical activity, even for such short "
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    ABSTRACT: Metabolic disturbances are a growing concern for the treatment of schizophrenia. As decreased activity and poor sleep quality are risk factors for metabolic disturbances, we investigated the activity and sleep patterns of schizophrenic patients using actigraphy. Seventy-three patients with schizophrenia spectrum disorder (mean age 29.2 ± 10.2 years, 27 females) treated with olanzapine (n = 54) or risperidone (n = 19) and 36 age- and sex-matched healthy controls were examined. Actigraphic recordings were obtained throughout seven consecutive days. The Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS) were used to assess sleep and daytime sleepiness. Drug side effects were evaluated with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and Barnes Akathisia Rating Scale (BARS). Mental status was rated with the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS). The patients had lower mean 24 h-activity (p < 0.001) and mean 10 h-daytime-activity (p < 0.001), and longer time in bed (p < 0.001). Higher PANSS scores, especially in the negative symptoms scale, were related to lower activity (r(s) = -0.508, p < 0.001). Higher depressive symptoms were related to lower mean 24 h-activity (r(s) = -0.233, p = 0.049), longer time in bed (r(s) = 0.315, p = 0.007) and higher AIS (r(s) = 0.377, p = 0.001) and ESS scores (r(s) = 0.321, p = 0.006). Healthy females presented higher activity than healthy males (p < 0.001). Similar but not significant gender differences were observed in the patients. These findings show that patients with schizophrenia treated with olanzapine or risperidone exhibit low physical activity and altered sleep pattern which may promote metabolic side effects. These changes are linked to negative and depressive symptoms.
    Journal of Psychiatric Research 06/2011; 45(10):1381-6. DOI:10.1016/j.jpsychires.2011.05.009 · 3.96 Impact Factor
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    • "All patients of 18 years and older with schizophrenia or related psychotic disorders covered by a mental health care centre in a circumscribed area in The Netherlands were included in yearly routine outcome assessments of their physical and mental health as described previously [40] [41]. Assessments were carried out between January 2003 and April 2006 in patients having given informed consent in accordance with the latest version of the Declaration of Helsinki. "
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    ABSTRACT: Antidepressants are frequently prescribed in patients with psychotic disorders, but little is known about their effects in routine clinical practice. The objective was to investigate the prescribing patterns of antidepressants in relation to the course of depressive symptoms in patients with psychotic disorders. A cohort of 214 Dutch patients with psychotic disorders received two assessments of somatic and psychiatric health, including a clinician-rated screening for depressive symptoms, as part of annual routine outcome monitoring. Depressive symptoms were prevalent among 43% (93) of the patients. Antidepressants were prescribed for 40% (86) of the patients and the majority 83% (71) continued this therapy after one year. Multivariable analysis showed that patients with more severe psychopathology had a higher risk to develop depressive symptoms the following year (OR [95% CI]=0.953 [0.912-0.995]). For patients with depressive symptoms at baseline, polypharmacy was a potential risk factor to keep having depressive symptoms (OR [95% CI]=1.593 [1.123-2.261]). Antidepressant use was not an independent predictor in both analyses. Routine outcome monitoring in patients with psychotic disorders revealed a high prevalence of depressive symptoms. Antidepressants were frequently prescribed and continued in routine clinical practice.
    European Psychiatry 02/2011; 27(4):240-4. DOI:10.1016/j.eurpsy.2010.10.007 · 3.44 Impact Factor
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