Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: A cross-sectional assessment of a primary health care database

ArticleinEuropean Psychiatry 23(2):100-8 · April 2008with4 Reads
Impact Factor: 3.44 · DOI: 10.1016/j.eurpsy.2007.07.005 · Source: PubMed
Abstract

To determine the prevalence of metabolic syndrome (MS) in outpatients treated with antipsychotics included in a primary-health-care database. A cross-sectional study was carried out assessing an administrative outpatients claim-database from 5 primary-health-centers. Subjects on antipsychotics for more than 3 months were included. The control group was formed by the outpatients included in the database without exposition to any antipsychotic drugs. MS was defined according to the modified NCEP-ATP III criteria, and required confirmation of at least 3 of the 5 following components: body mass index >28.8 kg/m(2), triglycerides >150 mg/ml, HDL-cholesterol <40 mg/ml (men)/<50mg/ml (women), blood pressure >130/85 mmHg, and fasting serum glucose >110 mg/dl. We identified 742 patients [51.5% women, aged 55.1 (20.7) years] treated with first- or second-generation antipsychotics during 27.6 (20.3) months. Controls were 85.286 outpatients [50.5% women, aged 45.5 (17.7) years]. MS prevalence was significantly higher in subjects on antipsychotics: 27.0% (95% CI, 23.8-30.1%) vs. 14.4% (14.1-14.6%); age- and sex-adjusted OR=1.38 (1.16-1.65, P<0.001). All MS components, except high blood pressure, were significantly more prevalent in the antipsychotic group, particularly body mass index >28.8 kg/m(2): 33.0% (29.6-36.4%) vs. 17.8% (17.6-18.1%), adjusted OR=1.63 (1.39-1.92, P<0.001), and low HDL-cholesterol levels: 48.4% (44.8-52.0%) vs. 29.3% (29.0-29.6%); adjusted OR=1.65 (1.42-1.93, P<0.001). Compared with the reference population, subjects with schizophrenia or bipolar disorder (BD), but not dementia, showed a higher prevalence of MS. Compared with the general outpatient population, the prevalence of MS was significantly higher in patients with schizophrenia or BD treated with antipsychotics.

    • ".... Risk of metabolic syndrome is also higher among patients with schizophrenia and bipolar disorder [9]. Moreover, patients with anxiety and major depression have higher prevalence of hypertension compar..."
      In patients with schizophrenia, the most prevalent CVR factors are hyperlipidaemia (61 %), smoking (55 %), obesity (41 %), diabetes (19 %) and hypertension (17 %)) [8]. Risk of metabolic syndrome is also higher among patients with schizophrenia and bipolar disorder [9]. Moreover, patients with anxiety and major depression have higher prevalence of hypertension compared to groups of similar age from the general population [10, 11].
    [Show abstract] [Hide abstract] ABSTRACT: Background: Cardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population. Methods: MEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95 % confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality. Results: A total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7 %), depressive disorders (14.7 %), SMI (11.4 %) and bipolar disorders (8.6 %). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively). Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95 % CI:-0.02 to 0.71], p = 0.06); high heterogeneity was observed (I (2) = 93 %; p < 0.001). Conclusions: The summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population. The systematic review is registered in PROSPERO: CRD42013003898 .
    Full-text · Article · Dec 2016 · BMC Psychiatry
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    • "...ide effects (especially for second-generation antipsychotics) (Marsden and Jenner 1980; Sicras-Mainar et al. 2008; Hasan et al. 2013 metabolism. It is thought that abnormal polyunsaturated fatty acid (PUFA) metabol..."
      These symptoms interfere with the ability to concentrate and work in patients who are diagnosed with schizophrenia. Antipsychotic drugs can treat these psychotic symptomatology but are often associated with extrapyramidal (especially for first-generation antipsychotics) and metabolic side effects (especially for second-generation antipsychotics) (Marsden and Jenner 1980; Sicras-Mainar et al. 2008; Hasan et al. 2013 metabolism. It is thought that abnormal polyunsaturated fatty acid (PUFA) metabolism occurs due to overactive phospholipase A2 (PLA2) in schizophrenia, which generates free fatty acids (such as arachidonic acid or AA, eicosapentaenoic acid or EPA, docosahexaenoic acid or DHA) from the phospholipid membrane (Peet and Horrobin 2002; van Rensburg et al. 2009).
    [Show abstract] [Hide abstract] ABSTRACT: Current psychopharmacological approaches to reduce psychotic phenomenology in schizophrenia are associated with adverse effects including extrapyramidal and metabolic side effects. In view of the emerging data on nutritional supplementation interventions in schizophrenia which are not entirely consistent, we aimed to review existent studies focusing on fatty acid and vitamin interventions and summarise current evidence on such nutritional supplementations in schizophrenia. We searched the digital databases (ScienceDirect, Scopus, SpringerLINK, PubMed/Medline) for relevant studies pertaining to fatty acid and vitamin supplementation interventions in the management of psychotic symptoms in schizophrenia up to February 2015. Overall, there were more studies conducted on fatty acid over vitamin supplementations in patients with schizophrenia. There were more positive findings in support of fatty acid supplementation compared with vitamin supplementation in the context of specific intervention features (dose of nutrient supplementation, single versus combination nutritional interventions, specific antipsychotic), subject features (older age, long duration of illness, baseline polyunsaturated fatty acid levels) and clinical outcomes (improvements of psychotic symptoms and/or extrapyramidal side effects from antipsychotics). However, investigations of both supplementation modalities were limited by relatively small study sample sizes, short study duration, which precluded further segmentation of impact on more diverse patient subtypes and symptom profiles. Future studies may consider examining larger samples over a longer time period, recruiting younger subjects with shorter duration of illness, examination of different clinical features including specific cognitive domains, and use of single versus combination nutritional interventions.
    Full-text · Article · Sep 2015 · Journal of Neural Transmission
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    • "...n countries are not homogeneous, and our data seem comparable with some [20] but not all [19,21,22,47] studies. Along with methodological issues, it may well be that Mediterranean healthy dietary habits..."
      Finally, Mediterranean healthy dietary habits could be important protective factors, reducing CVD risk factors, such as hypertriglyceridemia and insulin resistance [38,46]. However, findings on CVD risk factors rates in people with SMI from other Mediterranean countries are not homogeneous, and our data seem comparable with some [20] but not all [19,21,22,47] studies. Along with methodological issues, it may well be that Mediterranean healthy dietary habits in different Southern Europe countries are influenced by others factors such as area-level socio-economic position and wealth [48].
    [Show abstract] [Hide abstract] ABSTRACT: Objective. This study aimed to explore the prevalence of CVDs risk factors in people with severe mental illness (SMI), estimating its weight on related risks in Southern Europe, an area with distinct dietary traditions. People with SMI may be more likely than general population to have high prevalence of risk factors for cardiovascular diseases (CVDs), due to several reasons, including poor health behaviours and psychopharmacological medications. Method. A cross-sectional study has been conducted, comparing inpatients with and without SMI. Univariate and multivariate analyses and logistic regression models have been carried out, exploring the effect of SMI on the prevalence of CVDs risk factors. Results. Although obesity and hypertriglyceridemia were more prevalent among people with SMI, controlling for relevant confounders in multivariate analyses we could not detect any significant difference. Conclusions. People with SMI may not necessarily have higher CVDs risk, as compared with general population. Mediterranean healthy dietary habits, universal health coverage, families providing strong support, all are possible explanations for our findings. Further research is needed, exploring different mechanisms, with more detailed biological and genetics measures.
    Full-text · Article · Nov 2014 · General Hospital Psychiatry
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