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Metabolic syndrome in mental health and addiction treatment: A quantitative study

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Abstract

Accessible summary: Patients with mental illnesses have been found to shorter life expectancy due to an increased risk of heart disease. Some medication used to treat mental illnesses have been linked to weight gain and other physical change that make patients susceptible to heart disease. In order to reduce this risk it is important that health professionals regularly measure and monitor signs of these physical changes. This research has found that measuring both waist circumference and blood pressure of patients is a safe and reliable way to way to monitor patients. To identify if combined blood pressure and waist circumference measurements are reliable predictor of metabolic syndrome, a descriptive correlational design was used to examine the sensitivity and specificity of screening techniques used to detect metabolic syndrome. Data were collected regarding waist circumference, body mass index, blood pressure, fasting blood glucose, triglycerides and high-density lipoproteins. Blood pressure and waist circumference measurements demonstrated high significance, sensitivity and specificity as screening instruments for metabolic syndrome. Combined waist circumference and blood pressure measurements may be clinically useful for a quick and reliable detection of metabolic syndrome in patients with addiction and comorbid mental health problems.

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... Recent studies show that there is a link between opioid and alcohol addiction and an increased incidence of MetS as well as cardiovascular diseases (Davoodi et al. 2006;Flynn et al. 2015;Karam et al. 2004;Mohammadi et al. 2009). Moreover, the risk of developing MetS and its components was associated with alcohol addiction. ...
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Background We aimed to assess the association between opioid addiction and metabolic syndrome (MetS) risk and its components. Methods We used data obtained from the Rafsanjan Cohort Study (RCS), as a part of the prospective epidemiological research studies in IrAN (PERSIAN). The diagnosis of MetS was accomplished using three criteria of the International Diabetes Federation (IDF), Iranian IDF, and National Cholesterol Education Panel-Adult Treatment Panel III (NCEP-ATP III). Using a questionnaire, data for the demographic, anthropometric, and laboratory indices was collected. Results The prevalence of MetS was 38.30, 31.58, and 34.42% based on the IDF international, IDF Iranian, and NCEP-ATP III criteria. According to the IDF international criteria, 666 (17.45%) cases were using opioids and there was a statistically significant difference between opioid use and prevalence of MetS (p < 0.001). Based on the NCEP-ATP III criteria, there was a significant difference in the prevalence of MetS based on opioid use (p < 0.001). Use of opioids was associated significantly with a decreased odds of MetS in the multivariate model based on the IDF international (Adjusted OR = 0.85, 95% CI 0.74–0.98) and IDF Iranian criteria (Adjusted OR = 0.83, 95% CI 0.72–0.95). Conclusions Prevalence of MetS was lower in subjects using opioids. Opioid use was associated with a decreased risk of MetS development.
... It is also important to note that female patients seem to be at a higher risk of centriptal obesity. (Flynn et al, 2015). The CATIE study found that obesity is not present in the first psychotic episode in most schizophrenic patients, which is contrary to the notion pointed by other ...
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The association between severe mental illnesses and increased mortality risk has been well described for centuries. Psychiatric patients have their life expectancy reduced between 1.4 and 32 years old, being the subgroup of schizophrenic patients the one that shows a higher reduction in life expectancy, between 10 to 25 years. The standardized mortality ratios are higher in patients with schizophrenia for all causes of death, leaded by cardiovascular disease. It has also been suggested that the gap between the life expectancy of patients with schizophrenia and the general population has been increasing during the last decades. This phenomenon is still not fully understood, and it is probably due to multiple causes, among which a higher incidence of cardiovascular risk factors, and prejudice in the screening and treatment of medical conditions surely play an important role. The nature of the disease and the treatment itself may also contribute. The diagnosis of schizophrenia has a profound impact on every aspect of the patients' life. These patients are often victims of scarce investment from health care professionals both regarding the investigation of symptomatic concerns and the treatment of comorbidities that will, all together, reduce the patients' life expectancy and increase their suffering and disability. In this paper, we aim to answer these deceivingly simple questions: What is, after all, the average life expectancy of a patient with schizophrenia? How has the average life expectancy evolved over time? What are the main causes of death of patients with schizophrenia?
... It is also important to note that female patients seem to be at a higher risk of centriptal obesity. (Flynn et al, 2015). The CATIE study found that obesity is not present in the first psychotic episode in most schizophrenic patients, which is contrary to the notion pointed by other ...
Article
Full-text available
The association between severe mental illnesses and increased mortality risk has been well described for centuries. Psychiatric patients have their life expectancy reduced between 1.4 and 32 years old, being the subgroup of schizophrenic patients the one that shows a higher reduction in life expectancy, between 10 to 25 years. The standardized mortality ratios are higher in patients with schizophrenia for all causes of death, leaded by cardiovascular disease. It has also been suggested that the gap between the life expectancy of patients with schizophrenia and the general population has been increasing during the last decades. This phenomenon is still not fully understood, and it is probably due to multiple causes, among which a higher incidence of cardiovascular risk factors, and prejudice in the screening and treatment of medical conditions surely play an important role. The nature of the disease and the treatment itself may also contribute. The diagnosis of schizophrenia has a profound impact on every aspect of the patients' life. These patients are often victims of scarce investment from health care professionals both regarding the investigation of symptomatic concerns and the treatment of comorbidities that will, all together, reduce the patients' life expectancy and increase their suffering and disability. In this paper, we aim to answer these deceivingly simple questions: What is, after all, the average life expectancy of a patient with schizophrenia? How has the average life expectancy evolved over time? What are the main causes of death of patients with schizophrenia?
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Objective: The aim of this study was to examine the prevalence of metabolic syndrome (MS) and related factors in patients with schizophrenia at an outpatient clinic. Method: All 108 patients with schizophrenia or schizoaffective disorder that presented to the outpatient clinic between 12 May and 12 June 2006 were included in the study. Of the 108 patients, 100 whose biochemical analyses were completed were assessed. Results: The prevalence of MS was 21%, 34%, and 41% according to ATP III, ATP III-A, and IDF criteria, respectively. Increased waist circumference and low HDL level were frequent among the patients. The prevalence of MS increased with age. Mean age, duration of illness and duration of treatment were higher and family history of obesity was common in the patients with MS. Discussion: The prevalence of ATP III-defined MS in patients with schizophrenia was lower compared to that reported in other studies; however, the prevalence of MS was high based on ATP III-A and IDF criteria. Patients with schizophrenia are at increased risk for MS or related metabolic problems. In particular, when risk factors such as older age, female gender, long duration of illness and treatment, and family history of obesity exist, clinicians should examine the metabolic condition of the patient. Increased waist circumference and low HDL level are probably the best predictors of MS.
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Metabolic syndrome and other cardiovascular risk factors are highly prevalent in people with schizophrenia. Patients are at risk for premature mortality and overall have limited access to physical health care. In part these cardio-metabolic risk factors are attributable to unhealthy lifestyle, including poor diet and sedentary behaviour. But over recent years it has become apparent that antipsychotic agents can have a negative impact on some of the modifiable risk factors. The psychiatrist needs to be aware of the potential metabolic side effects of antipsychotic medication and to include them in the risk/benefit assessment when choosing a specific antipsychotic. He should also be responsible for the implementation of the necessary screening assessments and referral for treatment of any physical illness. Multidisciplinary assessment of psychiatric and medical conditions is needed. The somatic treatments offered to people with severe and enduring mental illness should be at par with general health care in the non-psychiatrically ill population.
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Our aim was to study the frequency of metabolic syndrome and associated factors in patients with schizophrenia. The study group consisted of 35 outpatients with long-term schizophrenia defined by DSM-IV criteria. Patients were assessed for the presence of metabolic syndrome, which was defined by the criteria of the National Cholesterol Education Program. All patients were on antipsychotic medication. Data were collected from Jan. 1, 2001, to Aug. 30, 2001. Metabolic syndrome was found in 37% (N = 13) of the patients, and it was associated inversely with the total daily dose of, but not with any specific type of, antipsychotic drug. The results suggest that metabolic syndrome is common among patients with schizophrenia, and it may be far more common than in general populations.
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This study attempted to estimate the relative risk of developing hyperlipidemia after treatment with antipsychotics in relation to no antipsychotic treatment. A matched case-control analysis was performed with pharmacy and claims data from California Medicaid (Medi-Cal). Patients were excluded if they were treated for medical disorders or prescribed medications known to increase their risk of hyperlipidemia. Cases were ages 18 to 64 years with schizophrenia, major depression, bipolar disorder, or other affective psychoses and incident hyperlipidemia. Cases were matched to up to six control subjects by age, sex, race, and psychiatric diagnosis. Both groups were prescribed either no antipsychotic medication or had two or more prescriptions for one and only one antipsychotic medication during the 60 days prior to the first indication of hyperlipidemia (cases) or matched index date (controls) in the billing record. Conditional logistic regressions were used to derive odds ratios and 95% confidence intervals (95% CIs) of each antipsychotic medication in relation to no antipsychotic medication. A total of 13,133 incident cases of hyperlipidemia were matched to 72,140 control subjects. As compared with no antipsychotic medication, treatment with clozapine (odds ratio: 1.82, 95% CI: 1.61-2.05), risperidone (odds ratio: 1.53, 95% CI: 1.43-1.64), quetiapine (odds ratio: 1.52, 95% CI: 1.40-1.65), olanzapine (odds ratio: 1.56, 95% CI: 1.47-1.67), ziprasidone (odds ratio: 1.40, 95% CI: 1.19-1.65), and first-generation antipsychotics (odds ratio: 1.26, 95% CI: 1.14-1.39), but not aripiprazole (odds ratio: 1.19, 95% CI: 0.94-1.52) was associated with a significant increase in risk of incident hyperlipidemia. These findings suggest that most commonly prescribed antipsychotic medications increase the risk of developing hyperlipidemia in patients with schizophrenia or mood disorders.
Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults
Hyperlipidemia following treatment with antipsychotic medications
  • Olfson M.