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Luckhoff HK, Smit AM, Phahladira L, Kilian S, Emsley R, Asmal L. Childhood trauma associations with changes in body mass index over 12 months of treatment in first-episode schizophrenia spectrum disorders. Schizophr Res 2025; 281:52-59. [PMID: 40318310 DOI: 10.1016/j.schres.2025.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 03/27/2025] [Accepted: 04/28/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Childhood trauma (CT) is a risk factor for the development of adulthood obesity, both in the general population, and in patients with schizophrenia. AIM We examined the associations between CT exposure and visit-wise changes in body mass index (BMI) over 12 months of treatment in patents with first-episode schizophrenia spectrum disorders (FES) (n = 77) compared to matched controls (n = 55). We also examined the moderating effects of socio-demographic, clinical, and treatment-related factors on the relationships between CT exposure and weight gain in patients. METHODS CT was assessed using the Childhood Trauma Questionnaire. BMI was assessed at baseline in patients and controls and again at regular 3-month intervals in patients. Linear mixed effect models for continuous repeated measures (MMRM) were constructed to examine the effects of CT exposure on visit-wise changes in BMI over time. RESULTS Patients had a lower baseline BMI than controls, but were balanced for CT exposure. In patients, but not in controls, more severe childhood emotional abuse (EA) correlated with a higher baseline BMI. Initial MMRM indicated that higher childhood EA was associated with more pronounced weight gain over 12 months in patients. Explorative MMRM indicated that this effect was limited to cannabis non-users, and no longer significant in cannabis users. DISCUSSION Cannabis use moderated the association between childhood EA and more pronounced weight gain in FES. Future studies would do well to examine the effects of other risk and resilience factors on the relationships between CT exposure and metabolic syndrome changes in schizophrenia.
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Affiliation(s)
- H K Luckhoff
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - A M Smit
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Phahladira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Nissen L, Løkke A, Frølund JC, Hilberg O, Højlund M, Ejlersen E, Hjorth P. Medical consultation to identify somatic disorders and abnormal paraclinical findings in hospitalized psychiatric patients is feasible and worthwhile. Nord J Psychiatry 2025; 79:249-258. [PMID: 40156501 DOI: 10.1080/08039488.2025.2484387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 02/17/2025] [Accepted: 03/20/2025] [Indexed: 04/01/2025]
Abstract
PURPOSE While psychiatric treatment mostly focuses on mental health, comorbid somatic conditions are frequent and often undertreated. This study aimed to bridge the gap by assessing the feasibility of medical consultations for psychiatric inpatients and to identify somatic and lifestyle-related conditions, as well as abnormal paraclinical findings. Secondly, we aimed to identify psychiatric treatments and diagnoses associated with metabolic outcomes. MATERIALS AND METHODS Patients admitted to Department of Psychiatry Vejle, Denmark, between October 2022 and December 2023 were invited to participate in a medical consultation. The consultations gathered data on comorbidities and lifestyle, including smoking habits, alcohol and drug use, and body metrics. Additionally, information on medical treatment and biochemical markers was collected. RESULTS A total of 238 patients were enrolled [mean age 48.2 ± 18.6 years; 50.8% were men]. Health assessment revealed that 111 (46.6%) were active smokers and 129 (54.2%) had a body mass index (BMI) of ≥ 25 kg/m2. Biochemical analysis showed that 78 (32.8%) had vitamin D levels below 50 nmol/L and 89 (38%) had a low-density lipoprotein level >3 mmol/L. Patients treated with two or more antipsychotic drugs had a significantly higher BMI (4.6 kg/m2, 95% CI: 0.8-8.3) compared with individuals not taking antipsychotic medication. CONCLUSION The study demonstrates that medical consultations for hospitalized psychiatric patients are feasible and important, revealing abnormal biochemical markers and significant somatic comorbidities and lifestyle-related conditions. These findings suggest that routine medical assessments could enhance patient treatment and care and guide targeted interventions for metabolic and somatic health issues in psychiatric settings.
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Affiliation(s)
- Louise Nissen
- Department of Psychiatry, Vejle. Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Vejle Hospital, a Part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Psychiatry, Aabenraa. Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Jannie Christina Frølund
- Department of Medicine, Vejle Hospital, a Part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Psychiatry, Aabenraa. Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Ole Hilberg
- Department of Medicine, Vejle Hospital, a Part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Psychiatry, Aabenraa. Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Mikkel Højlund
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Aabenraa. Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Ejler Ejlersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Vejle Hospital, a Part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Peter Hjorth
- Department of Psychiatry, Vejle. Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Suschana E, Anderson T, Hong C, Narikatte A, Silverberg J, Sharma MS. The role of anti-inflammatory diets and supplementation in metabolic syndrome and symptom remission in adults with schizophrenia: a systematic review. Front Psychiatry 2025; 15:1506353. [PMID: 39839138 PMCID: PMC11747649 DOI: 10.3389/fpsyt.2024.1506353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 12/02/2024] [Indexed: 01/23/2025] Open
Abstract
Introduction Immune dysregulation and chronic inflammation have been hypothesized as potential pathways in metabolic syndrome and schizophrenia. Anti-inflammatory diets have the potential not only to treat metabolic syndrome but also to reduce the symptom burden in schizophrenia. The aim of this systematic review was to investigate the role of anti-inflammatory diets and vitamin supplementation in the management of metabolic syndrome and in symptom remission in people with schizophrenia. Methods This systematic review included research articles from PubMed, EMBASE, Scopus, PsycINFO, and the Cochrane Central Register for Controlled Trials. The primary outcomes were markers of metabolic syndrome and symptoms of psychosis. Results Our search identified 2,124 potential studies, of which 1,559 were screened based on the title and abstract, resulting in 81 full-text articles assessed for eligibility. A total of 17 studies were included, which demonstrated mixed findings on the impacts of anti-inflammatory diet interventions on metabolic markers and symptom remission in schizophrenia. Prebiotic, probiotic, and fish oil supplementation showed improvements in metabolic markers. Fish oil and vitamin D supplementation demonstrated symptom remission in some trials. Conclusion It is important to consider that people with schizophrenia may experience common external barriers that hinder adherence to dietary interventions. These findings underscore the need for larger trials with standardized dietary protocols and consistent metabolic and symptom outcome measures in order to better understand the potential role of anti-inflammatory interventions in this population. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024511596.
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Affiliation(s)
- Elizabeth Suschana
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Thea Anderson
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Catriona Hong
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Arun Narikatte
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, United States
| | - Jillian Silverberg
- Library Services, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Manu Suresh Sharma
- Department of Psychiatry, Institute of Living, Hartford, CT, United States
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Taub S, Menkes-Caspi N, Fruchtman-Steinbok T, Kamhi-Nesher S, Krivoy A. Patients with severe mental illness in the general emergency department: Clinical characteristics, quality of care and challenges. Gen Hosp Psychiatry 2025; 92:100-105. [PMID: 39754825 DOI: 10.1016/j.genhosppsych.2024.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 11/30/2024] [Accepted: 11/30/2024] [Indexed: 01/06/2025]
Abstract
BACKGROUND Morbidity and mortality rates are notably higher among individuals with severe mental illnesses (SMI). People with SMI often have lower access to healthcare services, and the medical care they receive is known to be suboptimal. Consequently, treatment in an acute care setting rather than a community setting is more common. We aim to explore medical care in the emergency department (ED) for people with SMI compared to a control population. METHODS In this matched cohort study, data on all adult Clalit Health Services (CHS) members who were referred to the general ED during the years 2018-2021 were extracted. Patients with SMI (ICD-10 codes for schizophrenia, schizoaffective disorder, and bipolar disorder) were matched with a control group of ED patients without SMI in a 1:3 ratio. The two groups were compared regarding ED admission reasons, management, and outcomes. RESULTS The total sample (n = 92,848) included ED patients with SMI (n = 23,212) and without (n = 69,636). The most common ED admission reasons in both groups were pain, traumatic injury, and cardiac symptoms. Patients in the SMI group had higher rates of diagnosed diabetes mellitus and obstructive pulmonary disease. ED assessment, measured by resource allocation, was less comprehensive for patients with SMI who presented with subjective complaints such as pain and weakness, while it was comparable between patients with and without SMI for other main presenting complaints. Workup for patients with SMI lasted longer and necessitated hospitalization at higher rates for most admission reasons. Mortality during the study period was almost twice as high among the SMI group (5 % vs. 2.3 %, p < 0.001). DISCUSSION Our findings indicate higher rates of morbidity and treatment complexity among patients with SMI. As expected, the mortality rate was higher in this group. An alarming gap in resource allocation for ED assessment was observed when patients presented with subjective complaints. Enhanced awareness and integrated resources in primary care are required to improve the management and physical healthcare of patients with SMI.
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Affiliation(s)
- Sharon Taub
- Geha Mental Health Center, Petach Tikva, Israel; Geha Mental Health Data Research Center, Petach Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | | | | | - Shiri Kamhi-Nesher
- Geha Mental Health Center, Petach Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Rarinca V, Vasile A, Visternicu M, Burlui V, Halitchi G, Ciobica A, Singeap AM, Dobrin R, Burlui E, Maftei L, Trifan A. Relevance of diet in schizophrenia: a review focusing on prenatal nutritional deficiency, obesity, oxidative stress and inflammation. Front Nutr 2024; 11:1497569. [PMID: 39734678 PMCID: PMC11673491 DOI: 10.3389/fnut.2024.1497569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 11/29/2024] [Indexed: 12/31/2024] Open
Abstract
BACKGROUND/OBJECTIVES Schizophrenia is a complex mental disorder influenced by genetic and environmental factors, including dietary habits. Oxidative stress and inflammation play a crucial role in the pathophysiology of schizophrenia. Emerging research suggests that diet may affect schizophrenia through different biological mechanisms beyond oxidative stress and inflammation. In particular, epigenetic changes may alter the expression of genes related to neurodevelopment and neurotransmitter systems, while neuroplasticity plays a crucial role in brain adaptation and resilience to psychiatric disorders. METHODS The literature search included the main available databases (Science Direct, PubMed and Google Scholar), considering the English language, and our screening was performed based on several words such as "schizophrenia", "diet", "nutrients", "obesity", "oxidative stress", "inflammation", "antioxidants" and "prenatal nutritional deficiency". The review focused specifically on studies examining the relevance of diet in schizophrenia, as well as prenatal nutritional deficiency, obesity, oxidative stress, and inflammation associated with this disorder. RESULTS Following a review of the literature, it was found that nutritional deficiencies, including lack of omega-3 fatty acids, vitamins D, and B, during the prenatal and postnatal periods can have a negative impact on neurodevelopment and increase the risk of schizophrenia. Patients with schizophrenia have imbalances in antioxidant enzymes, such as glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), and reduced levels of antioxidants (vitamin E, vitamin C). These biochemical changes lead to an increase in markers of oxidative stress, including malondialdehyde (MDA). In addition, cytokine-mediated inflammation, microglial activation, and intestinal dysbiosis are associated with the onset of schizophrenia and the severity of schizophrenia symptoms. Currently, there is no universally accepted dietary regimen for control. However, various diets and nutritional methods are being researched and applied to alleviate the symptoms of schizophrenia and improve the overall health of patients, including the Mediterranean diet, the ketogenic diet, the gluten-free diet, and the DASH (Dietary Approaches to Stop Hypertension) diet. CONCLUSION A healthy diet, rich in anti-inflammatory nutrients and antioxidants, may help manage schizophrenia by reducing oxidative stress, preventing complications, and improving quality of life. Omega-3 fatty acids, vitamin D, and B vitamins are particularly important for brain development and function. In this review, we aim to analyze the literature on the influence of diet on schizophrenia, focusing on the role of prenatal nutritional deficiencies, obesity, oxidative stress, and inflammation.
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Affiliation(s)
- Viorica Rarinca
- Doctoral School of Geosciences, Faculty of Geography and Geology, Alexandru Ioan Cuza University of Iasi, Iași, Romania
- Doctoral School of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iași, Iași, Romania
- Preclinical Department, Apollonia University, Iași, Romania
| | - Amalia Vasile
- Faculty of Biology, “Alexandru Ioan Cuza” University of Iași, Iași, Romania
| | - Malina Visternicu
- Doctoral School of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iași, Iași, Romania
- Preclinical Department, Apollonia University, Iași, Romania
| | - Vasile Burlui
- Preclinical Department, Apollonia University, Iași, Romania
| | | | - Alin Ciobica
- Preclinical Department, Apollonia University, Iași, Romania
- Faculty of Biology, “Alexandru Ioan Cuza” University of Iași, Iași, Romania
- CENEMED Platform for Interdisciplinary Research, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, Iași, Romania
- Romanian Academy of Scientists, Bucharest, Romania
| | - Ana-Maria Singeap
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon”, Iași, Romania
| | - Romeo Dobrin
- “Socola” Psychiatric Institute, Iași, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | | | - Lucian Maftei
- SC MAKEUP SHOP SRL – Cosmetics Product Development Department, Iași, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon”, Iași, Romania
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Hanna MR, Caspi A, Houts RM, Moffitt TE, Torvik FA. Co-occurrence between mental disorders and physical diseases: a study of nationwide primary-care medical records. Psychol Med 2024:1-13. [PMID: 39552403 DOI: 10.1017/s0033291724002575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2024]
Abstract
BACKGROUND Mental disorders and physical-health conditions frequently co-occur, impacting treatment outcomes. While most prior research has focused on single pairs of mental disorders and physical-health conditions, this study explores broader associations between multiple mental disorders and physical-health conditions. METHODS Using the Norwegian primary-care register, this population-based cohort study encompassed all 2 203 553 patients born in Norway from January 1945 through December 1984, who were full-time residents from January 2006 until December 2019 (14 years; 363 million person-months). Associations between seven mental disorders (sleep disturbance, anxiety, depression, acute stress reaction, substance-use disorders, phobia/compulsive disorder, psychosis) and 16 physical-health conditions were examined, diagnosed according to the International Classification of Primary Care. RESULTS Of 112 mental-disorder/physical-health condition pairs, 96% of associations yielded positive and significant ORs, averaging 1.41 and ranging from 1.05 (99.99% CI 1.00-1.09) to 2.38 (99.99% CI 2.30-2.46). Across 14 years, every mental disorder was associated with multiple different physical-health conditions. Across 363 million person-months, having any mental disorder was associated with increased subsequent risk of all physical-health conditions (HRs:1.40 [99.99% CI 1.35-1.45] to 2.85 [99.99% CI 2.81-2.89]) and vice versa (HRs:1.56 [99.99% CI 1.54-1.59] to 3.56 [99.99% CI 3.54-3.58]). Associations were observed in both sexes, across age groups, and among patients with and without university education. CONCLUSIONS The breadth of associations between virtually every mental disorder and physical-health condition among patients treated in primary care underscores a need for integrated mental and physical healthcare policy and practice. This remarkable breadth also calls for research into etiological factors and underlying mechanisms that can explain it.
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Affiliation(s)
- Matthew R Hanna
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Avshalom Caspi
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
- Promenta Research Center, University of Oslo, Oslo, Norway
| | - Renate M Houts
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Terrie E Moffitt
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
- Promenta Research Center, University of Oslo, Oslo, Norway
| | - Fartein Ask Torvik
- Promenta Research Center, University of Oslo, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Ghasemi Noghabi P, Shahini N, Salimi Z, Ghorbani S, Bagheri Y, Derakhshanpour F. Elevated serum IL-17 A and CCL20 levels as potential biomarkers in major psychotic disorders: a case-control study. BMC Psychiatry 2024; 24:677. [PMID: 39394574 PMCID: PMC11468266 DOI: 10.1186/s12888-024-06032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/20/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Major psychotic disorders (MPD), including schizophrenia (SCZ) and schizoaffective disorder (SAD), are severe neuropsychiatric conditions with unclear causes. Understanding their pathophysiology is essential for better diagnosis, treatment, and prognosis. Recent research highlights the role of inflammation and the immune system, particularly the Interleukin 17 (IL-17) family, in these disorders. Elevated IL-17 levels have been found in MPD, and human IL-17 A antibodies are available. Changes in chemokine levels, such as CCL20, are also noted in SCZ. This study investigates the relationship between serum levels of IL-17 A and CCL20 in MPD patients and their clinical characteristics. METHOD We conducted a case-control study at the Ibn Sina Psychiatric Hospital (Mashhad, Iran) in 2023. The study involved 101 participants, of which 71 were MPD patients and 30 were healthy controls (HC). The Positive and Negative Symptom Scale (PANSS) was utilized to assess the symptoms of MPD patients. Serum levels of CCL20 and IL-17 A were measured using Enzyme-Linked Immunosorbent Assay (ELISA) kits. We also gathered data on lipid profiles and Fasting Blood Glucose (FBS). RESULTS The mean age of patients was 41.04 ± 9.93 years. The median serum levels of CCL20 and IL-17 A were significantly elevated in MPD patients compared to HC (5.8 (4.1-15.3) pg/mL and 4.2 (3-5) pg/mL, respectively; p < 0.001). Furthermore, CCL20 and IL-17 A levels showed a positive correlation with the severity of MPD. MPD patients also had significantly higher FBS, cholesterol, and Low-Density Lipoprotein (LDL) levels, and lower High-Density Lipoprotein (HDL) levels compared to HC. No significant relationship was found between PANSS components and blood levels of IL17 and CCL20. CONCLUSION The current study revealed that the serum levels of IL-17 A and CCL20 in schizophrenia patients are higher than those in the control group. Metabolic factors such as FBS, cholesterol, HDL, and LDL also showed significant differences between MPD and HC. In conclusion, the findings suggest that these two inflammatory factors could serve as potential therapeutic targets and prognostic biomarkers for schizophrenia.
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Affiliation(s)
- Parisa Ghasemi Noghabi
- Department of Psychiatry, Faculty of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Najmeh Shahini
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
| | - Zanireh Salimi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Ghorbani
- Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Yasser Bagheri
- Clinical Research Development Unit (CRDU), Agh ghala Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
- Immunology department, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Firoozeh Derakhshanpour
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran.
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Ding M, Zhang S, Zhu Z, Cai R, Fang J, Zhou C, Zhang X, Fang X. Influencing factors of different metabolic status in hospitalized patients with schizophrenia. Front Psychiatry 2024; 15:1436142. [PMID: 39091455 PMCID: PMC11291240 DOI: 10.3389/fpsyt.2024.1436142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Objective The aim of this study was to explore the risk factors for different metabolic status in patients with schizophrenia. Methods A total of 968 hospitalized patients with schizophrenia were recruited. Fasting blood glucose (GLU) and lipid profile, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) were measured. Schizophrenia patients were divided into four groups: normal metabolism and weight (NMNW), abnormal metabolism and normal weight (AMNW), normal metabolism and overweight/obesity (NMO), and abnormal metabolism and overweight/obesity (AMO). Results Our results showed that NMNW, AMNW, NMO, and AMO accounted for 25.3%, 12.7%, 25.4%, and 36.6%, respectively. There were significant differences in age, disease duration, body mass index (BMI), waist circumference, chronic disease, systolic blood pressure (SBP), diastolic blood pressure (DBP), GLU, TG, TC, HDL-C, and LDL-C among these four groups (all p < 0.05). With the NMNW group as the reference, the disordered multiple classification regression analysis showed that chronic disease was a significant risk factor for AMNW (OR = 5.271, 95% CI = 3.165 to 8.780, p < 0.001) and AMO (OR = 3.245, 95% CI = 2.004 to 5.254, p < 0.001), age was an important protective factor for NMO (OR = 0.968, 95% CI = 0.943 to 0.994, p = 0.015) and AMO (OR = 0.973, 95% CI = 0.948 to 0.999, p < 0.042), waist circumference was a significant risk factor for NMO (OR = 1.218, 95% CI = 1.180 to 1.257, p < 0.001) and AMO (OR = 1.252, 95% CI = 1.212 to 1.291, p < 0.001), and college education was an obvious protective factor for AMO (OR = 0.343, 95% CI = 0.123 to 0.953, p < 0.040) among patients with schizophrenia. Conclusion The findings of our study underscored the importance of factors such as age, education level, chronic disease, and waist circumference when exploring the influencing factors and biological mechanisms of obesity-related metabolic problems in schizophrenia patients.
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Affiliation(s)
- Mubing Ding
- Department of Psychiatry, Beijing Anding Hospital Affiliated to Capital Medical University Wuhu Hospital & Wuhu Fourth People’s Hospital, Wuhu, China
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shaotong Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zaochen Zhu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Renliang Cai
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jin Fang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangrong Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyu Fang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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DeMarco JT, Iennaco JD. AMPlifying metabolic screening for inpatients on antipsychotic medications with a nurse-driven protocol. Arch Psychiatr Nurs 2024; 49:113-117. [PMID: 38734446 DOI: 10.1016/j.apnu.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Patients on antipsychotic medications are at higher risk of developing metabolic syndrome; nevertheless, metabolic screening for patients on antipsychotics is suboptimal. METHODS This project developed and implemented AMP (Antipsychotic Metabolic screening Protocol), a nurse-driven protocol on inpatient psychiatric units that allowed nursing staff to collect all components of a metabolic screening. Nurses working on units with AMP were surveyed pre- and post-implementation on perception of AMP and empowerment. RESULTS AMP significantly increased overall metabolic screening as well as the most frequently missing component (lipid panel). The screening rates pre-intervention were similar to those found in the literature (on average, only two-thirds of patients were screened). However, AMP improved the rate such that nine out of every ten patients on the units were screened. Nurses had a negative perception and no change in empowerment from AMP implementation. CONCLUSIONS AMP can be used to increase metabolic screening for patients on antipsychotics. Further research is needed to better understand adoptability of nurse-driven protocols in the psychiatric inpatient setting as well as other applications, such as smoking cessation or safety sitters.
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Affiliation(s)
- James T DeMarco
- George Mason University, 4400 University Drive, MSN 3C4, United States of America.
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Charitos IA, Aliani M, Tondo P, Venneri M, Castellana G, Scioscia G, Castellaneta F, Lacedonia D, Carone M. Biomolecular Actions by Intestinal Endotoxemia in Metabolic Syndrome. Int J Mol Sci 2024; 25:2841. [PMID: 38474087 DOI: 10.3390/ijms25052841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Metabolic syndrome (MetS) is a combination of metabolic disorders that concurrently act as factors promoting systemic pathologies such as atherosclerosis or diabetes mellitus. It is now believed to encompass six main interacting conditions: visceral fat, imbalance of lipids (dyslipidemia), hypertension, insulin resistance (with or without impairing both glucose tolerance and fasting blood sugar), and inflammation. In the last 10 years, there has been a progressive interest through scientific research investigations conducted in the field of metabolomics, confirming a trend to evaluate the role of the metabolome, particularly the intestinal one. The intestinal microbiota (IM) is crucial due to the diversity of microorganisms and their abundance. Consequently, IM dysbiosis and its derivate toxic metabolites have been correlated with MetS. By intervening in these two factors (dysbiosis and consequently the metabolome), we can potentially prevent or slow down the clinical effects of the MetS process. This, in turn, may mitigate dysregulations of intestinal microbiota axes, such as the lung axis, thereby potentially alleviating the negative impact on respiratory pathology, such as the chronic obstructive pulmonary disease. However, the biomolecular mechanisms through which the IM influences the host's metabolism via a dysbiosis metabolome in both normal and pathological conditions are still unclear. In this study, we seek to provide a description of the knowledge to date of the IM and its metabolome and the factors that influence it. Furthermore, we analyze the interactions between the functions of the IM and the pathophysiology of major metabolic diseases via local and systemic metabolome's relate endotoxemia.
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Affiliation(s)
- Ioannis Alexandros Charitos
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumology and Respiratory Rehabilitation Unit, "Istitute" of Bari, 70124 Bari, Italy
| | - Maria Aliani
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumology and Respiratory Rehabilitation Unit, "Istitute" of Bari, 70124 Bari, Italy
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Maria Venneri
- Istituti Clinici Scientifici Maugeri IRCCS, Genomics and Proteomics Laboratory, "Istitute" of Bari, 70124 Bari, Italy
| | - Giorgio Castellana
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumology and Respiratory Rehabilitation Unit, "Istitute" of Bari, 70124 Bari, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Francesca Castellaneta
- School of Clinical Biochemistry and Pathology, University of Bari (Aldo Moro), 70124 Bari, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Mauro Carone
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumology and Respiratory Rehabilitation Unit, "Istitute" of Bari, 70124 Bari, Italy
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11
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Guan X, Chen Y, Wang X, Xiu M, Wu F, Zhang X. Total antioxidant capacity, obesity and clinical correlates in first-episode and drug-naïve patients with schizophrenia. Schizophr Res 2024; 264:81-86. [PMID: 38113675 DOI: 10.1016/j.schres.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/02/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Overweight/obesity is a growing concern in schizophrenia (SZ). A few studies have shown that excessive oxidative stress and abnormal antioxidants were associated with pathogenesis and psychiatric symptoms in first episode antipsychotics naïve (FEAN) patients with SZ. However, there is no study has explored the interrelationships between total antioxidant status (TAS) and the severity of psychiatric symptoms in the early stage of SZ. This study aimed to evaluate the impact of overweight/obesity on psychiatric symptoms in FEAN patients with SZ. METHODS A total of 241 patients with FEAN SZ and 119 healthy controls were recruited and symptoms were evaluated by the Positive and Negative Syndrome Scale (PANSS). TAS levels were also measured in patients and healthy controls. RESULTS We found a significant negative association between body mass index (BMI) and TAS in FEAN patients, but not in controls. In addition, BMI and TAS were negatively associated with psychiatric symptoms. Interestingly, further regression analysis revealed that the interaction between BMI and TAS was associated with the negative symptoms in the early stage of SZ. CONCLUSIONS Our study indicates that abnormal TAS levels interacting with overweight/obesity may be involved in the pathophysiology of SZ, in particular negative symptoms.
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Affiliation(s)
- Xiaoni Guan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Yuping Chen
- Qingdao Mental Health Center, Qingdao, China
| | - Xin Wang
- Qingdao Mental Health Center, Qingdao, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
| | - Xiangyang Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.
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12
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Mortimer KRH, Katshu MZUH, Chakrabarti L. Second-generation antipsychotics and metabolic syndrome: a role for mitochondria. Front Psychiatry 2023; 14:1257460. [PMID: 38076704 PMCID: PMC10704249 DOI: 10.3389/fpsyt.2023.1257460] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/10/2023] [Indexed: 05/15/2025] Open
Abstract
Psychosis is a known risk factor for developing metabolic syndrome (MetS). The risk is even greater in patients who are taking second-generation antipsychotics (SGAs). SGAs exacerbate metabolic abnormalities and lead to a 3-fold increased risk of severe weight gain, type 2 diabetes, and cardiovascular disease in patients. Mitochondrial dysfunction is a hallmark of MetS. Mitochondria process glucose and fatty acids into ATP. If these processes are impaired, it can result in dyslipidaemia, hyperglycaemia and an imbalance between nutrient input and energy output. This leads to increased adiposity, insulin resistance and atherosclerosis. It is unclear how SGAs induce MetS and how mitochondria might be involved in this process. It has been found that SGAs impair cellular glucose uptake in liver, dysregulating glucose and fatty acid metabolism which leads to an accumulation of glucose and/or lipids and an increase reactive oxygen species (ROS) which target mitochondrial proteins. This affects complexes of the electron transport chain (ETC) to reduce mitochondrial respiration. While there is a suggestion that SGAs may interact with a variety of processes that disrupt mitochondrial function, some of the results are conflicting, and a clear picture of how SGAs interact with mitochondria in different cell types has not yet emerged. Here, we outline the current evidence showing how SGAs may trigger mitochondrial dysfunction and lead to the development of MetS.
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Affiliation(s)
| | - Mohammed Zia Ul Haq Katshu
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Lisa Chakrabarti
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
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13
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Wei YM, Wang XJ, Yang XD, Wang CS, Wang LL, Xu XY, Zhao GJ, Li B, Zhu DM, Wu Q, Shen YF. Safety and effectiveness of lurasidone in the treatment of Chinese schizophrenia patients: An interim analysis of post-marketing surveillance. World J Psychiatry 2023; 13:937-948. [DOI: 10.5498/wjp.v13.i11.937] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Schizophrenia is a psychiatric disorder characterized by chronic or recurrent symptoms. Lurasidone was licensed in China in 2019 for the treatment of adult schizophrenia in adults with a maximum dose of 80 mg/d. However, post-market surveillance (PMS) with an adequate sample size is required for further validation of the drug’s safety profile and effectiveness.
AIM To conduct PMS in real-world clinical settings and evaluate the safety and effectiveness of lurasidone in the Chinese population.
METHODS A prospective, multicenter, open-label, 12-wk surveillance was conducted in mainland China. All patients with schizophrenia from 10 sites who had begun medication with lurasidone between September 2019 and August 2022 were eligible for enrollment. Safety assessments included adverse events (AEs), adverse drug reactions (ADRs), extrapyramidal symptoms (EPS), akathisia, use of EPS drugs, weight gain, and laboratory values as metabolic parameters and the QTc interval. The effectiveness was assessed using the brief psychiatric rating scale (BPRS) from baseline to the end of treatment.
RESULTS A total of 965 patients were enrolled in the full analysis set and 894 in the safety set in this interim analysis. The average daily dose was 61.7 ± 19.08 mg (mean ± SD) during the treatment. AEs and ADRs were experienced by 101 patients (11.3%) and 78 patients (8.7%), respectively, which were mostly mild. EPS occurred in 25 individuals with a 2.8% incidence, including akathisia in 20 individuals (2.2%). Moreover, 59 patients received drugs for treating EPS during the treatment, with an incidence of 6.6% which dropped to 5.4% at the end of the treatment. The average weight change was 0.20 ± 2.36 kg (P = 0.01687) with 0.8% of patients showing a weight gain of ≥ 7% at week 12 compared with that at the baseline. The mean values of metabolic parameters and the QTc interval at baseline and week 12 were within normal ranges. The mean changes in total BPRS scores were -8.9 ± 9.76 (n = 959), -13.5 ± 12.29 (n = 959), and -16.8 ± 13.97 (n = 959) after 2/4, 6/8, and 12 wk, respectively (P < 0.001 for each visit compared with the baseline) using the last-observation-carried-forward method.
CONCLUSION The interim analysis of the PMS of adult patients with schizophrenia demonstrate the safety and effectiveness of lurasidone in the Chinese population. No new safety or efficacy concerns were identified.
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Affiliation(s)
- Yu-Mei Wei
- Shanghai Clinical Research Center for Mental Health, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xi-Jin Wang
- Department of Psychiatry, The First Psychiatric Hospital of Harbin, Harbin 150056, Heilongjiang Province, China
| | - Xiao-Dong Yang
- Department of Psychiatry, Shandong Provincial Mental Health Center, Jinan 250014, Shandong Province, China
| | - Chuan-Sheng Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
| | - Li-Li Wang
- Department of Psychiatry, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin 300222, China
| | - Xiao-Ying Xu
- Department of Psychiatry, The Fifth People’s Hospital of Zigong, Zigong 643020, Sichuan Province, China
| | - Gui-Jun Zhao
- Department of Psychiatry, Guangyuan Mental Health Center, Guangyuan 628001, Guizhou Province, China
| | - Bin Li
- Department of Psychology, Fujian Energy General Hospital, Fuzhou 350001, Fujian Province, China
| | - Dao-Min Zhu
- Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People’s Hospital, Anhui Mental Health Center, Hefei 230022, Anhui Province, China
| | - Qi Wu
- Sumitomo Pharma (China), Co., Ltd., Shanghai 200025, China
| | - Yi-Feng Shen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Clinical Research Center for Mental Health, Shanghai Jiao Tong University, Shanghai 200030, China
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14
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Kaasgaard DM, Stryhn L, Veldt Larsen P, Fisker L, Friis Elliott A, Høgh L, Thunberg R, Knudsgaard Sørensen M, Martinsen P, Kjær Hansen H, Munk-Jørgensen P, Hjorth P. Outpatients with psychotic disorders need physical health-promoting treatment: A cross-sectional multisite study. Heliyon 2023; 9:e21670. [PMID: 38034687 PMCID: PMC10681925 DOI: 10.1016/j.heliyon.2023.e21670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Impaired quality of life (QoL) and premature death in patients with primary non-affective psychotic disorders is related to lifestyle-induced comorbidities. Current municipal health-promoting treatment and care do not embrace the challenges of living with psychotic disorders. Aim This cross-sectional study aimed to identify the proportion of outpatients diagnosed with primary psychotic disorders who need health-promoting treatment and care, and who receive municipal health-promoting interventions. Methods Of 206 eligible invited outpatients from three psychiatric services clinics in Southern Denmark, 165 participated. Demographic and health characteristics, and use of alcohol, cannabis, drugs, and cigarettes were identified via a screening tool. Blood test information, body measurements, and medication status were extracted from the outpatients' medical records. The need for health promotion was assessed based on body mass index (BMI), and use of alcohol, cannabis, drugs, and cigarettes. Results Seventy-three percent of outpatients needed health promotion, of whom 61 % were not offered municipal health-promoting treatment and care. Thirty-six percent had one or more somatic comorbidities, including diabetes mellitus (15 %) and cardiovascular disease (10 %); 41 % smoked a mean (SD) of 19 (10) cigarettes daily. Mean (SD) BMI was 34 (8) kg/m2 for women and 29 (7) kg/m2 for men. Conclusion The majority of outpatients with non-affective psychotic disorders need health-promoting interventions, but only about 40 % of these patients receive such municipal health-promoting treatment and care. Future studies should clarify the impact of these interventions on the health status, QoL, and life expectancy of these patients.
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Affiliation(s)
- Didde Marie Kaasgaard
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, 5000 Odense, Denmark
- Psychiatric Research Academy, Mental Health Services Region of Southern Denmark, 5000 Odense, Denmark
| | - Lene Stryhn
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, 5000 Odense, Denmark
- Psychiatric Research Academy, Mental Health Services Region of Southern Denmark, 5000 Odense, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, 7100 Vejle, Denmark
| | - Lone Fisker
- Institute of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Anja Friis Elliott
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, 6715 Esbjerg, Denmark
| | - Lene Høgh
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Rolf Thunberg
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | | | - Pernille Martinsen
- Mental Health Services in the Region of Southern Denmark, 5700 Svendborg, Denmark
| | - Hanne Kjær Hansen
- Mental Health Services in the Region of Southern Denmark, 5700 Svendborg, Denmark
| | - Povl Munk-Jørgensen
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, 5000 Odense, Denmark
- Psychiatric Research Academy, Mental Health Services Region of Southern Denmark, 5000 Odense, Denmark
| | - Peter Hjorth
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, 5000 Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, 7100 Vejle, Denmark
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15
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Lamadé EK, Özer N, Schaupp B, Krumm B, Deuschle M, Häfner S. Association of hypertension, type 2 diabetes mellitus and dyslipidemia with the duration of inpatient treatments and recurrence of schizophrenia. J Psychosom Res 2023; 172:111436. [PMID: 37454415 DOI: 10.1016/j.jpsychores.2023.111436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE People with schizophrenia have an increased cardiovascular risk with higher mortality than the general population. Only a few studies have investigated the impact of cardiovascular risk on the later course of schizophrenia. This study aims to explore the association of cardiovascular risk factors, as detected during an index inpatient treatment for schizophrenia, with the duration of psychiatric inpatient treatments and number of inpatient admissions in the subsequent 10 years, in patients with schizophrenia. METHODS Cardiovascular risk factors of 736 patients with schizophrenia, identified through retrospective chart review, were assessed by hypertension, type 2 diabetes mellitus and dyslipidemia during an index inpatient stay. The duration of inpatient treatments, assessed by the total duration of psychiatric inpatient treatments in days, and the number of inpatient admissions, over the next 10 years were assessed and analyzed for an association with cardiovascular risk factors. RESULTS Hypertension associated with longer duration of inpatient treatments and higher number of inpatient admissions. Type 2 diabetes mellitus and dyslipidemia associated with a higher number of psychiatric inpatient treatments. Hypertension remained significantly associated with the duration of inpatient treatments (β = 0.174; p < 0.001) and the number of inpatient treatments (β = 0.144; p < 0.001), when adjusting for age, sex and BMI. CONCLUSION Out of the investigated cardiovascular risk factors documented during an index inpatient stay for schizophrenia, only hypertension associated with an increased duration of in-hospital stay and an increased number of re-hospitalizations during the subsequent ten years when adjusting for confounders. Screening for hypertension should be considered in all patients with schizophrenia.
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Affiliation(s)
- Eva Kathrin Lamadé
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Nicole Özer
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Bernhard Schaupp
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bertram Krumm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sibylle Häfner
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany; Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
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16
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Zhang L, Zhu M, Liu X, Zhao Z, Han P, Lv L, Yang C, Han Y. Calorie-restricted diet mitigates weight gain and metabolic abnormalities in obese women with schizophrenia: a randomized controlled trial. Front Nutr 2023; 10:1038070. [PMID: 37215202 PMCID: PMC10198382 DOI: 10.3389/fnut.2023.1038070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Background Obesity is a prevalent health problem in patients with schizophrenia, and calorie restriction diet (CRD) achieved effective weight loss and metabolic improvement; however, these have not been rigorously evaluated in obese patients with schizophrenia. Objective To measure the effects of CRD on weight loss and metabolic status in hospitalized obese women with schizophrenia during a 4-week period. Methods Participants were randomly assigned to two groups in a 1:1 ratio. The intervention group (n = 47) was asked to follow a CRD and the control group (n = 48) a normal diet for 4 weeks. Outcomes of body weight, body composition, as well as metabolic parameters were measured at baseline and following the intervention period. Results Forty-five participants completed the 4-week research in both the intervention and control groups. Compared to the normal diet, adherence to the CRD significantly decreased body weight (2.38 ± 1.30 kg), body mass index (0.94 ± 0.52 kg/m2), waist circumference (4.34 ± 2.75 cm), hip circumference (3.37 ± 2.36 cm), mid-upper circumferences, triceps skin-fold thickness, fat mass and free fat mass with large effect sizes (p = <0.001, ηp2 range between 0.145 and 0.571), as well as total cholesterol (0.69 ± 0.70 mmol/L) with a medium effect size (p = 0.028, ηp2 = 0.054). There were no differences between the CRD and control groups in terms of pre-post changes in triglycerides, high- and low-density lipoprotein-cholesterols, as well as systolic and diastolic blood pressures (p > 0.05). Conclusion CRD is preventative of weight gain, but not apparent in intervention for metabolic status in hospitalized obese women with schizophrenia.Clinical trial registration: http://www.chictr.org.cn, ChiCTR-INR-16009185.
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Affiliation(s)
- Lei Zhang
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Mingwen Zhu
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Xiangqun Liu
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Zhijun Zhao
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Ping Han
- Department of Nutrition and Food Hygiene, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Luxian Lv
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
- Henan Key Lab of Biological Psychiatry of Xinxiang Medical University, Xinxiang, Henan, China
| | - Chun Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Capital Medical University, Beijing, China
| | - Yong Han
- Henan Key Lab of Biological Psychiatry of Xinxiang Medical University, Xinxiang, Henan, China
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17
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Saadullah Khani N, Cotic M, Wang B, Abidoph R, Mills G, Richards-Belle A, Perry BI, Khandaker GM, Bramon E. Schizophrenia and cardiometabolic abnormalities: A Mendelian randomization study. Front Genet 2023; 14:1150458. [PMID: 37091807 PMCID: PMC10115959 DOI: 10.3389/fgene.2023.1150458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Individuals with a diagnosis of schizophrenia are known to be at high risk of premature mortality due to poor physical health, especially cardiovascular disease, diabetes, and obesity. The reasons for these physical health outcomes within this patient population are complex. Despite well-documented cardiometabolic adverse effects of certain antipsychotic drugs and lifestyle factors, schizophrenia may have an independent effect. Aims: To investigate if there is evidence that schizophrenia is causally related to cardiometabolic traits (blood lipids, anthropometric traits, glycaemic traits, blood pressure) and vice versa using bi-directional two-sample Mendelian randomization (MR) analysis. Methods: We used 185 genetic variants associated with schizophrenia from the latest Psychiatric Genomics Consortium GWAS (n = 130,644) in the forward analysis (schizophrenia to cardiometabolic traits) and genetic variants associated with the cardiometabolic traits from various consortia in the reverse analysis (cardiometabolic traits to schizophrenia), both at genome-wide significance (5 × 10-8). The primary method was inverse-variance weighted MR, supported by supplementary methods such as MR-Egger, as well as median and mode-based methods. Results: In the forward analysis, schizophrenia was associated with slightly higher low-density lipoprotein (LDL) cholesterol levels (0.013 SD change in LDL per log odds increase in schizophrenia risk, 95% CI, 0.001-0.024 SD; p = 0.027) and total cholesterol levels (0.013 SD change in total cholesterol per log odds increase in schizophrenia risk, 95% CI, 0.002-0.025 SD; p = 0.023). However, these associations did not survive multiple testing corrections. There was no evidence of a causal effect of cardiometabolic traits on schizophrenia in the reverse analysis. Discussion: Dyslipidemia and obesity in schizophrenia patients are unlikely to be driven primarily by schizophrenia itself. Therefore, lifestyle, diet, antipsychotic drugs side effects, as well as shared mechanisms for metabolic dysfunction and schizophrenia such as low-grade systemic inflammation could be possible reasons for the apparent increased risk of metabolic disease in people with schizophrenia. Further research is needed to examine the shared immune mechanism hypothesis.
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Affiliation(s)
- Noushin Saadullah Khani
- Division of Psychiatry, Mental Health Neuroscience Department, University College London, London, United Kingdom
| | - Marius Cotic
- Division of Psychiatry, Mental Health Neuroscience Department, University College London, London, United Kingdom
- Department of Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Baihan Wang
- Division of Psychiatry, Mental Health Neuroscience Department, University College London, London, United Kingdom
| | - Rosemary Abidoph
- Division of Psychiatry, Mental Health Neuroscience Department, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Georgina Mills
- Division of Psychiatry, Mental Health Neuroscience Department, University College London, London, United Kingdom
| | - Alvin Richards-Belle
- Division of Psychiatry, Mental Health Neuroscience Department, University College London, London, United Kingdom
- Division of Psychiatry, Epidemiology and Applied Clinical Research Department, University College London, London, United Kingdom
| | - Benjamin I. Perry
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Golam M. Khandaker
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, United Kingdom
| | - Elvira Bramon
- Division of Psychiatry, Mental Health Neuroscience Department, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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18
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van Walree ES, Jansen IE, Bell NY, Savage JE, de Leeuw C, Nieuwdorp M, van der Sluis S, Posthuma D. Disentangling Genetic Risks for Metabolic Syndrome. Diabetes 2022; 71:2447-2457. [PMID: 35983957 DOI: 10.2337/db22-0478] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022]
Abstract
A quarter of the world's population is estimated to meet the criteria for metabolic syndrome (MetS), a cluster of cardiometabolic risk factors that promote development of coronary artery disease and type 2 diabetes, leading to increased risk of premature death and significant health costs. In this study we investigate whether the genetics associated with MetS components mirror their phenotypic clustering. A multivariate approach that leverages genetic correlations of fasting glucose, HDL cholesterol, systolic blood pressure, triglycerides, and waist circumference was used, which revealed that these genetic correlations are best captured by a genetic one factor model. The common genetic factor genome-wide association study (GWAS) detects 235 associated loci, 174 more than the largest GWAS on MetS to date. Of these loci, 53 (22.5%) overlap with loci identified for two or more MetS components, indicating that MetS is a complex, heterogeneous disorder. Associated loci harbor genes that show increased expression in the brain, especially in GABAergic and dopaminergic neurons. A polygenic risk score drafted from the MetS factor GWAS predicts 5.9% of the variance in MetS. These results provide mechanistic insights into the genetics of MetS and suggestions for drug targets, especially fenofibrate, which has the promise of tackling multiple MetS components.
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Affiliation(s)
- Eva S van Walree
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU Amsterdam, Amsterdam, the Netherlands
| | - Iris E Jansen
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU Amsterdam, Amsterdam, the Netherlands
| | - Nathaniel Y Bell
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU Amsterdam, Amsterdam, the Netherlands
| | - Jeanne E Savage
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU Amsterdam, Amsterdam, the Netherlands
| | - Christiaan de Leeuw
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU Amsterdam, Amsterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sophie van der Sluis
- Department of Child and Adolescent Psychology and Psychiatry, section Complex Trait Genetics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Danielle Posthuma
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU Amsterdam, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychology and Psychiatry, section Complex Trait Genetics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
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19
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Grant RK, Brindle WM, Donnelly MC, McConville PM, Stroud TG, Bandieri L, Plevris JN. Gastrointestinal and liver disease in patients with schizophrenia: A narrative review. World J Gastroenterol 2022; 28:5515-5529. [PMID: 36304087 PMCID: PMC9594005 DOI: 10.3748/wjg.v28.i38.5515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
Schizophrenia is a severe mental illness which can have a devastating impact on an individual's quality of life. Comorbidities are high amongst patients and life expectancy is approximately 15 years less than the general population. Despite the well-known increased mortality, little is known about the impact of gastrointestinal and liver disease on patients with schizophrenia. We aimed to review the literature and to make recommendations regarding future care. Literature searches were performed on PubMed to identify studies related to gastrointestinal and liver disease in patients with schizophrenia. High rates of chronic liver disease were reported, with Non-Alcoholic Fatty Liver Disease being of particular concern; antipsychotics and metabolic syndrome were contributing factors. Rates of acute liver failure were low but have been associated with antipsychotic use and paracetamol overdose. Coeliac disease has historically been linked to schizophrenia; however, recent research suggests that a causal link is yet to be proven. Evidence is emerging regarding the relationships between schizophrenia and peptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome; clinical vigilance regarding these conditions should be high. Patients with schizophrenia poorly engage with bowel cancer screening programmes, leading to late diagnosis and increased mortality. Clozapine induced constipation is a significant issue for many patients and requires close monitoring. There is a significant burden of gastrointestinal and liver disease amongst patients with schizophrenia. Better levels of support from all members of the medical team are essential to ensure that appropriate, timely care is provided.
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Affiliation(s)
- Rebecca K Grant
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - William M Brindle
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Mhairi C Donnelly
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Pauline M McConville
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - Thomas G Stroud
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - Lorenzo Bandieri
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - John N Plevris
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
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20
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Smith BJ, Brandão-Teles C, Zuccoli GS, Reis-de-Oliveira G, Fioramonte M, Saia-Cereda VM, Martins-de-Souza D. Protein Succinylation and Malonylation as Potential Biomarkers in Schizophrenia. J Pers Med 2022; 12:jpm12091408. [PMID: 36143193 PMCID: PMC9500613 DOI: 10.3390/jpm12091408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Two protein post-translational modifications, lysine succinylation and malonylation, are implicated in protein regulation, glycolysis, and energy metabolism. The precursors of these modifications, succinyl-CoA and malonyl-CoA, are key players in central metabolic processes. Both modification profiles have been proven to be responsive to metabolic stimuli, such as hypoxia. As mitochondrial dysfunction and metabolic dysregulation are implicated in schizophrenia and other psychiatric illnesses, these modification profiles have the potential to reveal yet another layer of protein regulation and can furthermore represent targets for biomarkers that are indicative of disease as well as its progression and treatment. In this work, data from shotgun mass spectrometry-based quantitative proteomics were compiled and analyzed to probe the succinylome and malonylome of postmortem brain tissue from patients with schizophrenia against controls and the human oligodendrocyte precursor cell line MO3.13 with the dizocilpine chemical model for schizophrenia, three antipsychotics, and co-treatments. Several changes in the succinylome and malonylome were seen in these comparisons, revealing these modifications to be a largely under-studied yet important form of protein regulation with broad potential applications.
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Affiliation(s)
- Bradley Joseph Smith
- Laboratory of Neuroproteomics, Institute of Biology, Department of Biochemistry and Tissue Biology, University of Campinas, Campinas 13083-862, Brazil
- Correspondence: (B.J.S.); (D.M.-d.-S.); Tel.: +55-(19)-3521-6129 (D.M.-d.-S.)
| | - Caroline Brandão-Teles
- Laboratory of Neuroproteomics, Institute of Biology, Department of Biochemistry and Tissue Biology, University of Campinas, Campinas 13083-862, Brazil
| | - Giuliana S. Zuccoli
- Laboratory of Neuroproteomics, Institute of Biology, Department of Biochemistry and Tissue Biology, University of Campinas, Campinas 13083-862, Brazil
| | - Guilherme Reis-de-Oliveira
- Laboratory of Neuroproteomics, Institute of Biology, Department of Biochemistry and Tissue Biology, University of Campinas, Campinas 13083-862, Brazil
| | - Mariana Fioramonte
- Laboratory of Neuroproteomics, Institute of Biology, Department of Biochemistry and Tissue Biology, University of Campinas, Campinas 13083-862, Brazil
| | - Verônica M. Saia-Cereda
- Laboratory of Neuroproteomics, Institute of Biology, Department of Biochemistry and Tissue Biology, University of Campinas, Campinas 13083-862, Brazil
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Institute of Biology, Department of Biochemistry and Tissue Biology, University of Campinas, Campinas 13083-862, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo 05403-000, Brazil
- Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas 13083-862, Brazil
- D’Or Institute for Research and Education (IDOR), São Paulo 04501-000, Brazil
- Correspondence: (B.J.S.); (D.M.-d.-S.); Tel.: +55-(19)-3521-6129 (D.M.-d.-S.)
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21
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Toledo FGS, Martin WF, Morrow L, Beysen C, Bajorunas D, Jiang Y, Silverman BL, McDonnell D, Namchuk MN, Newcomer JW, Graham C. Insulin and glucose metabolism with olanzapine and a combination of olanzapine and samidorphan: exploratory phase 1 results in healthy volunteers. Neuropsychopharmacology 2022; 47:696-703. [PMID: 34887529 PMCID: PMC8782841 DOI: 10.1038/s41386-021-01244-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 02/05/2023]
Abstract
A combination of olanzapine and samidorphan (OLZ/SAM) received US Food and Drug Administration approval in May 2021 for the treatment of adults with schizophrenia or bipolar I disorder. OLZ/SAM provides the efficacy of olanzapine, while mitigating olanzapine-associated weight gain. This exploratory study characterized the metabolic profile of OLZ/SAM in healthy volunteers to gain mechanistic insights. Volunteers received once-daily oral 10 mg/10 mg OLZ/SAM, 10 mg olanzapine, or placebo for 21 days. Assessments included insulin sensitivity during an oral glucose tolerance test (OGTT), hyperinsulinemic-euglycemic clamp, other measures of glucose/lipid metabolism, and adverse event (AE) monitoring. Treatment effects were estimated with analysis of covariance. In total, 60 subjects were randomized (double-blind; placebo, n = 12; olanzapine, n = 24; OLZ/SAM, n = 24). Olanzapine resulted in hyperinsulinemia and reduced insulin sensitivity during an OGTT at day 19, changes not observed with OLZ/SAM or placebo. Insulin sensitivity, measured by hyperinsulinemic-euglycemic clamp, was decreased in all treatment groups relative to baseline, but this effect was greatest with olanzapine and OLZ/SAM. Although postprandial (OGTT) glucose and fasting cholesterol concentrations were similarly increased with olanzapine or OLZ/SAM, other early metabolic effects were distinct, including post-OGTT C-peptide concentrations and aspects of energy metabolism. Forty-nine subjects (81.7%) experienced at least 1 AE, most mild or moderate in severity. OLZ/SAM appeared to mitigate some of olanzapine's unfavorable postprandial metabolic effects (e.g., hyperinsulinemia, elevated C-peptide) in this exploratory study. These findings supplement the body of evidence from completed or ongoing OLZ/SAM clinical trials supporting its role in the treatment of schizophrenia and bipolar I disorder.
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Affiliation(s)
- Frederico G. S. Toledo
- grid.21925.3d0000 0004 1936 9000Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | | | | | | | - Daiva Bajorunas
- Vault Bioventures, San Diego, CA USA ,Present Address: DBMD Consulting, Pompano Beach, FL USA
| | - Ying Jiang
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA
| | | | - David McDonnell
- grid.472773.20000 0004 0384 2510Alkermes Pharma Ireland Limited, Dublin, Ireland
| | - Mark N. Namchuk
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA ,grid.38142.3c000000041936754XPresent Address: Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA USA
| | - John W. Newcomer
- Thriving Mind South Florida, Miami, FL USA ,grid.4367.60000 0001 2355 7002Washington University School of Medicine, St. Louis, MO USA
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22
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Perez CSDH, Ciufolini S, Sood PG, Krivoy A, Young AH, Murray RM, Ismail K, Atakan Z, Greenwood K, Smith S, Gaughran F, Juruena MF. Predictive value of cardiometabolic biomarkers and depressive symptoms for symptom severity and quality of life in patients with psychotic disorders. J Affect Disord 2022; 298:95-103. [PMID: 34699852 DOI: 10.1016/j.jad.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/11/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with psychotic disorders show higher rates of the metabolic syndrome (MS) between the cluster of severe mental illnesses. Depressive symptoms can worsen outcomes of individuals with psychotic disorders. However, research on the association between MS and depression in psychotic disorders and their relevance to outcomes is lacking. METHODS We investigated the association between depression and cardiometabolic biomarkers in psychotic disorders and the predictive value of depressive symptoms on psychopathological severity and quality of life (QoL). 406 patients with psychotic disorders were recruited as part of the Improving Physical Health and Reducing Substance Use in Severe Mental Illness randomised controlled trial. Depression, psychotic symptoms, QoL, waist circumference, triglycerides, high-density lipoprotein cholesterol (HDL-C), blood pressure, and fasting glucose of patients were assessed at baseline and 12 months. Sensitivity analyses were conducted to test the effect of treatment. RESULTS More severe baseline symptoms of depression significantly predicted worse 12-month psychotic symptoms and lower mental health related QoL at 12 months. These associations held after controlling for alcohol use, gender, ethnicity, education, and mental health related QoL Baseline. Depressive symptoms also correlated with waist circumference at both baseline and 12 months, after controlling for multiple testing. CONCLUSION Individuals with psychotic disorders experiencing more severe depressive symptoms are more likely to have larger waist circumference contemporaneously and 12 months later, as well as more severe psychotic symptoms and worse QoL at follow-up. This highlights the need for evaluation of strategies to address depression in the management of psychotic disorders.
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Affiliation(s)
| | - Simone Ciufolini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | | | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Khalida Ismail
- Professor of Psychiatry and Medicine, Dept of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, United Kingdom
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, Denmark Hill, London, United Kingdom
| | - Kathryn Greenwood
- Clinical Research Fellow, Sussex Partnership NHS Foundation Trust, and Hon Senior Research Fellow, School of Psychology, University of Sussex
| | - Shubulade Smith
- Clinical Senior Lecturer, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London
| | - Fiona Gaughran
- Lead Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust and Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, United Kingdom
| | - Mario F Juruena
- Lead Consultant Psychiatrist, Maudsley Advanced Treatment Service, South London and Maudsley NHS Foundation Trust and Clinical Senior Lecturer in Translational Psychiatry, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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23
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Menand E, Moster R. Racial Disparities in the Treatment of Schizophrenia Spectrum Disorders: How Far Have We Come? Curr Behav Neurosci Rep 2021. [DOI: 10.1007/s40473-021-00236-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Citrome L, Graham C, Simmons A, Jiang Y, Todtenkopf MS, Silverman B, DiPetrillo L, Cummings H, Sun L, McDonnell D. An Evidence-Based Review of OLZ/SAM for Treatment of Adults with Schizophrenia or Bipolar I Disorder. Neuropsychiatr Dis Treat 2021; 17:2885-2904. [PMID: 34526769 PMCID: PMC8437420 DOI: 10.2147/ndt.s313840] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/14/2021] [Indexed: 12/19/2022] Open
Abstract
Olanzapine effectively treats schizophrenia and bipolar I disorder (BD-I); however, its use is limited by the risk of significant weight gain and metabolic effects. OLZ/SAM, a combination of olanzapine and samidorphan, was recently approved in the United States for the treatment of adults with schizophrenia or BD-I. OLZ/SAM provides the efficacy of olanzapine while mitigating olanzapine-associated weight gain through opioid-receptor blockade. Here, we summarize OLZ/SAM clinical data characterizing pharmacokinetics, antipsychotic efficacy, weight mitigation efficacy, safety, and long-term treatment effects. In an acute exacerbation of schizophrenia, OLZ/SAM and olanzapine provided similar symptom improvements versus placebo at week 4. In stable outpatients with schizophrenia, OLZ/SAM treatment resulted in significantly less weight gain, reducing the risk for clinically significant weight gain and waist circumference increases of ≥5 cm by half, compared with olanzapine at week 24. Based on open-label extension studies, OLZ/SAM is safe and well tolerated for up to 3.5 years of treatment, while maintaining schizophrenia symptom control and stabilizing weight. The olanzapine component of OLZ/SAM was bioequivalent to branded olanzapine (Zyprexa); adjunctive OLZ/SAM had no clinically significant effects on lithium or valproate pharmacokinetics. Additionally, OLZ/SAM had no clinically relevant effect on electrocardiogram parameters in a dedicated thorough QT study. Overall, safety and tolerability findings from clinical studies with OLZ/SAM indicate a similar safety profile to that of olanzapine, with the exception of less weight gain. As OLZ/SAM contains the opioid antagonist samidorphan, it is contraindicated in patients using opioids and in those undergoing acute opioid withdrawal. Clinical trial results from more than 1600 subjects support the use of OLZ/SAM as a new treatment option for patients with schizophrenia or BD-I.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | | | | | | | | | | | | | | | - Lei Sun
- Alkermes, Inc., Waltham, MA, USA
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25
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Boiko AS, Mednova IA, Kornetova EG, Gerasimova VI, Kornetov AN, Loonen AJM, Bokhan NA, Ivanova SA. Cytokine Level Changes in Schizophrenia Patients with and without Metabolic Syndrome Treated with Atypical Antipsychotics. Pharmaceuticals (Basel) 2021; 14:ph14050446. [PMID: 34065135 PMCID: PMC8150759 DOI: 10.3390/ph14050446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
The present study aims at comparing the change in cytokine levels in schizophrenia patients treated with atypical antipsychotics, with or without metabolic syndrome (MetS). The study included 101 patients with schizophrenia, 38 with and 63 without MetS, who received risperidone, quetiapine, olanzapine or aripiprazole for six weeks. We analyzed the concentration of 21 cytokines in the serum patients. The treatment with atypical antipsychotics changed some proinflammatory cytokine levels. It led to increased IFN-α2 (p = 0.010), IL-1α (p = 0.024) and IL-7 (p = 0.017) levels in patients with MetS, whereas the same treatment led to decreased levels of IFN-γ (p = 0.011), IL-1β (p = 0.035), IL-12р40 (p = 0.011), IL-17A (p = 0.031), IL-6 (p = 0.043) and TNF-α (p = 0.012) in individuals without MetS. Our results demonstrated the effects of atypical antipsychotics on the immune–inflammatory parameters, depending on the metabolic disturbances in schizophrenia patients.
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Affiliation(s)
- Anastasiia S. Boiko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya Str., 4, 634014 Tomsk, Russia; (A.S.B.); (I.A.M.); (V.I.G.); (N.A.B.); (S.A.I.)
| | - Irina A. Mednova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya Str., 4, 634014 Tomsk, Russia; (A.S.B.); (I.A.M.); (V.I.G.); (N.A.B.); (S.A.I.)
| | - Elena G. Kornetova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya Str., 4, 634014 Tomsk, Russia; (A.S.B.); (I.A.M.); (V.I.G.); (N.A.B.); (S.A.I.)
- University Hospital, Siberian State Medical University, Moskovsky Trakt, 2, 634050 Tomsk, Russia
- Correspondence:
| | - Valeria I. Gerasimova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya Str., 4, 634014 Tomsk, Russia; (A.S.B.); (I.A.M.); (V.I.G.); (N.A.B.); (S.A.I.)
| | - Alexander N. Kornetov
- Fundamental Psychology and Behavioral Medicine Department, Siberian State Medical University, Moskovsky Trakt, 2, 634050 Tomsk, Russia;
| | - Anton J. M. Loonen
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands;
| | - Nikolay A. Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya Str., 4, 634014 Tomsk, Russia; (A.S.B.); (I.A.M.); (V.I.G.); (N.A.B.); (S.A.I.)
- Psychiatry, Addictology and Psychotherapy Department, Siberian State Medical University, Moskovsky Trakt, 2, 634050 Tomsk, Russia
| | - Svetlana A. Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya Str., 4, 634014 Tomsk, Russia; (A.S.B.); (I.A.M.); (V.I.G.); (N.A.B.); (S.A.I.)
- Psychiatry, Addictology and Psychotherapy Department, Siberian State Medical University, Moskovsky Trakt, 2, 634050 Tomsk, Russia
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26
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Sud D, Laughton E, McAskill R, Bradley E, Maidment I. The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review. Syst Rev 2021; 10:92. [PMID: 33789745 PMCID: PMC8015120 DOI: 10.1186/s13643-021-01586-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness. METHODS A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool. RESULTS A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data. CONCLUSIONS Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086411.
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Affiliation(s)
- Dolly Sud
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Eileen Laughton
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Robyn McAskill
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Eleanor Bradley
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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27
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Vanwong N, Puangpetch A, Unaharassamee W, Jiratjintana N, Na Nakorn C, Hongkaew Y, Sukasem C. Effect of 5-HT2C receptor gene polymorphism (HTR2C-759C/T) on metabolic adverse effects in Thai psychiatric patients treated with risperidone. Pharmacoepidemiol Drug Saf 2021; 30:806-813. [PMID: 33683783 DOI: 10.1002/pds.5224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The use of Atypical antipsychotics (AAPs) is related to metabolic disturbances, which put psychiatric patients at risk for cardiovascular morbidity and mortality. Evidence is emerging of genetic risk factors. The HTR2C gene is an essential candidate in pharmacogenetic studies of antipsychotic-induced metabolic effects. Nevertheless, there were inconsistent results among studies. OBJECTIVE To investigate the relationship between -759C/T, functional polymorphism of the HTR2C gene and metabolic adverse effects in Thai psychiatric patients treated with risperidone monotherapy. METHOD In this cross-sectional study, 108 psychiatric patients treated with risperidone monotherapy for ≥3 months were recruited. Anthropometric measurements and laboratory tests were obtained upon enrollment and history of treatment was reviewed from medical records. Weight gain was defined as an increase ≥7% of baseline weight. Metabolic syndrome was evaluated according to the 2005 International Diabetes Federation (IDF) Asia criteria. The -759C/T, polymorphism was genotyped. The associations between -759C/T polymorphism and metabolic side effects were analyzed. Multiple logistic regression was used for determining potential confounders. RESULTS Neither weight gain nor metabolic syndrome was significantly associated with -759C/T allelic and genotype variants of HTR2C. However, T allele of -759C/T polymorphism significantly associated with the hypertension. This association was not affected by possible confounding factors such as gender, risperidone dose, duration of treatment and family history of hypertension. CONCLUSION Our findings suggest that psychiatric patients with T allele of -759C/T polymorphism may be at higher risk for hypertension. Further study with prospective design with larger patient groups are needed.
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Affiliation(s)
- Natchaya Vanwong
- Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Apichaya Puangpetch
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | | | - Napa Jiratjintana
- Department of Psychiatry, Somdet Chaopraya Institute of Psychiatry, Bangkok, Thailand
| | - Chalitpon Na Nakorn
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand.,Programme in Translational Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yaowaluck Hongkaew
- Advance Research and Development Laboratory, Bumrungrad International Hospital, Bangkok, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
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28
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Metabolic Syndrome and Dietary Habits in Hospitalized Patients with Schizophrenia: A Cross-Sectional Study. MEDICINA-LITHUANIA 2021; 57:medicina57030255. [PMID: 33801842 PMCID: PMC8001284 DOI: 10.3390/medicina57030255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The true prevalence of metabolic syndrome (MetS) and the reason for it being higher in patients with schizophrenia when compared to general population have not yet been fully determined. Although being considered as one of the major causes, currently there are limited findings regarding differences in dietary patterns of schizophrenic patients with and without MetS. The present study aimed to determine the prevalence of MetS among hospitalized patients with schizophrenia, to investigate the differences in socio-demographic, clinical, and lifestyle characteristics between participants with and without MetS, with the special emphasis being put on their dietary habits, and to ascertain the correlation between dietary habits and MetS components. Materials and Methods: A cross-sectional study included 259 hospitalized patients with schizophrenia aged ≥ 18 years. All participants underwent basic anthropometric measurements, blood sampling and blood pressure assessment, and provided relevant socio-demographic and lifestyle information. The presence of MetS was determined according to the Joint Interim Statement definition and dietary habits were assessed using a non-quantitative food frequency questionnaire. Results: The overall prevalence of MetS was 47.9%. No socio-demographic or lifestyle differences were found between participants with and without MetS. A large number of participants (42.9%) reported consuming carbonated soft drinks on a daily basis. Daily frequency of fruit (11.6%) and vegetables intake (29.3%) was far below recommended. Dietary habits of participants with and without MetS did not significantly differ, while consumption frequencies of some of the studied food and beverage items and groups significantly correlated with certain MetS components (such as statistically significant positive correlation between cured meat products consumption frequency and waist circumference, as well as between red meat consumption frequency and systolic blood pressure). Conclusions: The concept of the present study did not allow us to distinguish to what extent the participants’ dietary habits were influenced by independent procurement of food products, nor has it allowed us to quantify the portion sizes of consumed food and beverage items and groups. Nevertheless, the findings indicate the need for early identification of individuals with high MetS risk and for the incorporation of nutritional support programs into hospital treatment of patients with schizophrenia.
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Paderina DZ, Boiko AS, Pozhidaev IV, Bocharova AV, Mednova IA, Fedorenko OY, Kornetova EG, Loonen AJ, Semke AV, Bokhan NA, Ivanova SA. Genetic Polymorphisms of 5-HT Receptors and Antipsychotic-Induced Metabolic Dysfunction in Patients with Schizophrenia. J Pers Med 2021; 11:jpm11030181. [PMID: 33807811 PMCID: PMC7999828 DOI: 10.3390/jpm11030181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antipsychotic-induced metabolic syndrome (MetS) is a multifactorial disease with a genetic predisposition. Serotonin and its receptors are involved in antipsychotic-drug-induced metabolic disorders. The present study investigated the association of nine polymorphisms in the four 5-hydroxytryptamine receptor (HTR) genes HTR1A, HTR2A, HTR3A, and HTR2C and the gene encoding for the serotonin transporter SLC6A4 with MetS in patients with schizophrenia. METHODS A set of nine single-nucleotide polymorphisms of genes of the serotonergic system was investigated in a population of 475 patients from several Siberian regions (Russia) with a clinical diagnosis of schizophrenia. Genotyping was performed and the results were analyzed using chi-square tests. RESULTS Polymorphic variant rs521018 (HTR2C) was associated with higher body mass index in patients receiving long-term antipsychotic therapy, but not with drug-induced metabolic syndrome. Rs1150226 (HTR3A) was also associated but did not meet Hardy-Weinberg equilibrium. CONCLUSIONS Our results indicate that allelic variants of HTR2C genes may have consequences on metabolic parameters. MetS may have too complex a mechanistic background to be studied without dissecting the syndrome into its individual (causal) components.
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Affiliation(s)
- Diana Z. Paderina
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
| | - Anastasiia S. Boiko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
| | - Ivan V. Pozhidaev
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
| | - Anna V. Bocharova
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634050 Tomsk, Russia;
| | - Irina A. Mednova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
| | - Olga Yu. Fedorenko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
| | - Elena G. Kornetova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
- Siberian State Medical University, 634050 Tomsk, Russia
| | - Anton J.M. Loonen
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713AV Groningen, The Netherlands
- Correspondence:
| | - Arkadiy V. Semke
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
| | - Nikolay A. Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
- Siberian State Medical University, 634050 Tomsk, Russia
| | - Svetlana A. Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (D.Z.P.); (A.S.B.); (I.V.P.); (I.A.M.); (O.Y.F.); (E.G.K.); (A.V.S.); (N.A.B.); (S.A.I.)
- Siberian State Medical University, 634050 Tomsk, Russia
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Farhang S, Ghaemmaghami M, Shafiee-Kandjani AR, Noorazar SG, Veling W, Malek A, Somi MH, Bruggeman R, Alizadeh BZ. An Observational Cohort of First Episode Psychosis in Iran: The Azeri Recent Onset Acute Phase Psychosis Survey (ARAS Cohort) Study Protocol. Front Psychiatry 2021; 12:627960. [PMID: 33643098 PMCID: PMC7902483 DOI: 10.3389/fpsyt.2021.627960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Most of our knowledge about the etiology, course, treatment, and outcome of schizophrenia spectrum and other psychotic disorders stems from Western countries. Data from populations living in other geographical areas and low- and middle-income countries, with different genomes (ethnicity) and exposomes (e.g., culture and social support, drugs of abuse, religion), will add to our knowledge of this complex disorder. Methods: The Azeri Acute phase/Recent onset psychosis Survey (ARAS) has been initiated to study the course of the disorder in patients with recent-onset psychosis using validated diagnostic tools and a comprehensive outcome monitoring system, aiming to reveal indicators for understanding the risk and resilience factors and for choosing the best-personalized treatment strategy. All participants will be evaluated for clinical signs and symptoms as well as risk and resilience factors and will be followed up for 1, 3, and 5 years for outcomes in several domains. A hierarchical cluster method will be applied to identify the number of clusters for each outcome. Defined models will be applied to assess the predictive value of cognition on symptomatic and functional outcomes at follow-up. Discussion: The ARAS cohort will yield significant academic- (research and education) and care-related achievements. ARAS data and experience will have value both in being a useful model for other parts of this region and in an expansion of the currently available knowledge.
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Affiliation(s)
- Sara Farhang
- University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, University of Groningen, Groningen, Netherlands
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrdad Ghaemmaghami
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Reza Shafiee-Kandjani
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Gholamreza Noorazar
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ayyoub Malek
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Richard Bruggeman
- University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, University of Groningen, Groningen, Netherlands
| | - Behrooz Z. Alizadeh
- University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, University of Groningen, Groningen, Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Ashraf GM, Alghamdi BS, Alshehri FS, Alam MZ, Tayeb HO, Tarazi FI. Standardizing the Effective Correlated Dosage of Olanzapine and Empagliflozin in Female Wistar Rats. Curr Gene Ther 2021; 21:53-59. [PMID: 33183202 DOI: 10.2174/1566523220999201111195047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
Abstract
AIM The primary aim of this study was to standardize the correlated effective dosage of the antidiabetic drug empagliflozin (EMPA) and the antipsychotic drug olanzapine (Ola). BACKGROUND Atypical antipsychotics are associated with BWG and metabolic disturbances for which many approaches have been used to minimize these issues, including antidiabetic drugs. The antidiabetic drugs have been quite effective in reversing BWG induced by the administration of antipsychotic drugs in patients who have psychosis, schizophrenia and bipolar disorder. OBJECTIVE The objective of this study was to standardize the correlated effective dosage of EMPA and Ola. METHODS The study was carried out for 28 days to represent the chronic effect of Ola on female Wistar rats. Rats were divided into three groups based on the dose they received: control (vehicle), Ola-4 and Ola-8 (4 and 8 mg/kg/OD, respectively), and EMPA-10 and EMPA-20 (10 and 20 mg/kg/OD, respectively). RESULTS Both doses of Ola produced a significant increase in the percentage of BWG, however, Ola-4 produced a higher BWG. Also, both the doses of EMPA were able to reverse the effect of Ola-induced BWG; however, EMPA-20 produced a higher reversal in BWG and normalized the rat's body weight. CONCLUSION We conclude that Ola-4 and EMPA-20 were the most effective dosage for experimental purposes in female Wistar rats. The findings of this study standardized the effective correlated dosage of olanzapine and empagliflozin in female Wistar rats that will help understand the underlying molecular and behavioral mechanisms.
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Affiliation(s)
- Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Badrah S Alghamdi
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad S Alshehri
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammad Z Alam
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Haythum O Tayeb
- Division of Neurology, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Frank I Tarazi
- Department of Psychiatry and Neurology, Harvard Medical School and McLean Hospital, Belmont, MA 02478, United States
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Gupta B, Chee KS, Neo LQ, Tang C, Hariram J, Tan GCY, Verma S, Basu S, Appan DP, Ting CC, Abdin E, Lee J. Effect of aripiprazole as an adjunct to atypical antipsychotics on weight and metabolic profile: a 12-week open-label trial. Ther Adv Psychopharmacol 2021; 11:20451253211046765. [PMID: 34646440 PMCID: PMC8504280 DOI: 10.1177/20451253211046765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atypical antipsychotics are widely prescribed, yet have been associated with weight gain and metabolic syndrome. AIM To study the effect of adjunct low-dose aripiprazole on weight and metabolic parameters of subjects on atypical antipsychotics (olanzapine, clozapine or risperidone). METHODS The study was carried out as an open-label trial with a fixed dose of 5 mg aripiprazole added to the patient's current antipsychotic for 12 weeks. The primary outcome measure was mean change in weight, while secondary outcome measures included change in waist circumference; fasting blood glucose; HbA1c; triglycerides; total, HDL and LDL cholesterol levels; functioning; and neurocognition. RESULTS For the overall study (n = 55), there was no significant effect of adjunct aripiprazole on the weight of the subjects. However, the clozapine group achieved significant weight loss (p = 0.002) and also had significant improvements in total cholesterol (p < 0.001), HDL (p = 0.016), LDL (p = 0.044) and triglyceride levels (p = 0.038). The olanzapine group had significant improvement in triglycerides (p = 0.001), and other metabolic parameters for this group showed improvement trends, but did not reach statistical significance. The risperidone group did not show any significant improvement in weight or metabolic parameters. CONCLUSIONS The study adds support to the adjunctive use of aripiprazole to clozapine for weight loss and improvement in metabolic profile, and for reduction in cardiometabolic risk for patients on olanzapine. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02949752.
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Affiliation(s)
- Bhanu Gupta
- Institute of Mental Health, Singapore 539747
| | | | - Li-Qi Neo
- Institute of Mental Health, Singapore
| | | | | | | | | | | | | | | | | | - Jimmy Lee
- Institute of Mental Health, Singapore
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Understanding Mechanisms Underlying Non-Alcoholic Fatty Liver Disease (NAFLD) in Mental Illness: Risperidone and Olanzapine Alter the Hepatic Proteomic Signature in Mice. Int J Mol Sci 2020; 21:ijms21249362. [PMID: 33302598 PMCID: PMC7763698 DOI: 10.3390/ijms21249362] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with severe mental illness have increased mortality, often linked to cardio-metabolic disease. Non-alcoholic fatty liver disease (NAFLD) incidence is higher in patients with schizophrenia and is exacerbated with antipsychotic treatment. NAFLD is associated with obesity and insulin resistance, both of which are induced by several antipsychotic medications. NAFLD is considered an independent risk factor for cardiovascular disease, the leading cause of death for patients with severe mental illness. Although the clinical literature clearly defines increased risk of NAFLD with antipsychotic therapy, the underlying mechanisms are not understood. Given the complexity of the disorder as well as the complex pharmacology associated with atypical antipsychotic (AA) medications, we chose to use a proteomic approach in healthy mice treated with a low dose of risperidone (RIS) or olanzapine (OLAN) for 28 days to determine effects on development of NAFLD and to identify pathways impacted by AA medications, while removing confounding intrinsic effects of mental illness. Both AA drugs caused development of steatosis in comparison with vehicle controls (p < 0.01) and affected multiple pathways relating to energy metabolism, NAFLD, and immune function. AA-associated alteration in autonomic function appears to be a unifying theme in the regulation of hepatic pathology.
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Williams JC, Harowitz J, Glover J, Tek C, Srihari V. Systematic review of racial disparities in clozapine prescribing. Schizophr Res 2020; 224:11-18. [PMID: 33183948 DOI: 10.1016/j.schres.2020.07.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/29/2020] [Accepted: 07/26/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To conduct a systematic review of published evidence on clozapine prescribing disparities across racial and ethnic categories, estimate the size of these disparities, and assess possible causes to inform future monitoring and intervention. METHODS Electronic databases (MEDLINE, Embase, PsycINFO, Web of Science) were searched for directly relevant studies. Three independent reviewers selected studies: (1) of US samples; (2) directly addressed ethnic and/or racial disparities in prescribing of antipsychotic medications; (3) identified specific ethnic and/or racial groups (e.g. White, Blacks, Hispanics, non-Hispanic etc.); (4) reported clozapine prescription rates and (5) reported relevant covariates (i.e. gender, age, co-morbidities etc.). FINDINGS 16 studies met our eligibility criteria. All studies reported clozapine underutilization in ethnic and racial minority patients when compared to their white counterparts. These findings remained consistent despite different time periods, designs, data set types, and after controlling for relevant covariates such as: length of hospital stay, institutional setting, and disease severity. CONCLUSION The reasons for underutilization of clozapine in minority patients remain unclear. Various contributors can be categorized as: clinician-related factors (e.g. prescriber lack of experience), patient-related factors (e.g. distrust or suspicion of clinician), and institution-related factors (e.g. state operated facilities). Direct examination of these factors can help inform efforts to reduce clozapine prescription disparities.
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Affiliation(s)
| | - Jenna Harowitz
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jan Glover
- Yale University, Department of Psychiatry, New Haven, CT, USA
| | - Cenk Tek
- Yale University, Department of Psychiatry, New Haven, CT, USA
| | - Vinod Srihari
- Yale University, Department of Psychiatry, New Haven, CT, USA
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Sun MJ, Jang MH. Risk Factors of Metabolic Syndrome in Community-Dwelling People with Schizophrenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186700. [PMID: 32938011 PMCID: PMC7559252 DOI: 10.3390/ijerph17186700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/09/2020] [Accepted: 09/12/2020] [Indexed: 01/07/2023]
Abstract
This study investigated the prevalence and risk factors of metabolic syndrome in 100 community-dwelling people with schizophrenia registered in mental health facilities in Seoul, Korea. This study was conducted between 12 September and 15 November 2019. This study used a cross-sectional descriptive design. The data included were general and disease-related characteristics, diagnostic tests for metabolic syndrome, lifestyles, depression, and social support. The analysis of collected data was done by using the SPSS 24.0 program. The prevalence of metabolic syndrome was 42.0%. Higher body mass index (odds ratio [OR] = 1.60, 95% CI = 1.16–2.18, p = 0.004), and depression (OR = 1.22, 95% CI = 1.06–1.42, p = 0.008) were associated with higher risks of metabolic syndrome, while physical activity and weight control (OR = 0.71, 95% CI = 0.54–0.94, p = 0.018), dietary habits (OR = 0.72, 95% CI = 0.54–0.93, p = 0.011), and medication and health management (OR = 0.52, 95% CI = 0.31–0.86, p = 0.012) were associated with lower risks. Mental health care nurses need to recognize the high prevalence of metabolic syndrome in people with schizophrenia in the community and provide differentiated, customized lifestyle improvement programs based on the body mass index and depression status of each person with schizophrenia. Furthermore, comprehensive lifestyle improvement programs and health examination services that people with schizophrenia can easily adhere to should be developed.
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Svensson K, Hagström J, Blomqvist M, Jormfeldt H. "Waiting in the Wings"-Next-of-Kin's Experiences of Lifestyle Interventions for People with Schizophrenia. Issues Ment Health Nurs 2020; 41:832-839. [PMID: 32421461 DOI: 10.1080/01612840.2020.1731026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
People with schizophrenia have an increased risk of experiencing physical ill health and thus risk premature death. It is important to gain knowledge about the next-of-kin's experiences of lifestyle interventions in order to increase the understanding of the development of health promotion. This study aimed to describe the experiences of next-of-kin of lifestyle interventions for people with schizophrenia. Ten next-of-kin to people diagnosed with schizophrenia were interviewed and content analysis was used to analyze the data. Three categories emerged in the analysis: Low prioritization of physical health, Patients' needs for motivational support and Next-of-kin's' limited and distant participation. Mental health nurses need a holistic view of human beings and to include the patients' physical health and the role of the family in their responsibilities. Further studies are needed that focus on the views of the next-of-kin and the staff from the mental health services about the care and support needs for promoting physical health in this patient group.
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Affiliation(s)
- Kristina Svensson
- Department of Psychiatry, Psychiatric Clinic in Varberg, Region Halland, Sweden
| | - Johanna Hagström
- Department of Psychiatry, Psychiatric Clinic in Varberg, Region Halland, Sweden
| | - Marjut Blomqvist
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Vanhala V, Junkkari A, Korhonen VE, Kurki MI, Hiltunen M, Rauramaa T, Nerg O, Koivisto AM, Remes AM, Perälä J, Suvisaari J, Lehto SM, Viinamäki H, Soininen H, Jääskeläinen JE, Leinonen V. Prevalence of Schizophrenia in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery 2020; 84:883-889. [PMID: 29741669 PMCID: PMC6417909 DOI: 10.1093/neuros/nyy147] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/03/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a progressive and potentially treatable neurodegenerative disease affecting elderly people, characterized by gait impairment and ventricular enlargement in brain imaging. Similar findings are seen in some patients with schizophrenia (SCZ). OBJECTIVE To determine the prevalence of SCZ among patients suffering from probable or possible iNPH and the specific effects of comorbid SCZ on the outcome of the cerebrospinal fluid (CSF) shunting. METHODS All medical records of the 521 iNPH patients in the NPH registry were retrospectively analyzed from 1991 until 2017. The prevalence of comorbidity of SCZ was determined and compared to that of general aged (≥65 yr) population in Finland. RESULTS We identified a total of 16 (3.1%) iNPH patients suffering from comorbid SCZ. The prevalence of SCZ among the iNPH patients was significantly higher compared to the general population (3.1% vs 0.9%, P < .001). All iNPH patients with comorbid SCZ were CSF shunted and 12 (75%) had a clinically verified shunt response 3 to 12 mo after the procedure. The CSF shunt response rate did not differ between patients with and without comorbid SCZ. CONCLUSION SCZ seems to occur 3 times more frequently among iNPH patients compared to the general aged population in Finland. The outcome of the treatment was not affected by comorbid SCZ and therefore iNPH patients suffering from comorbid SCZ should not be left untreated. These results merit validation in other populations. In addition, further research towards the potential connection between these chronic conditions is warranted.
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Affiliation(s)
- Vasco Vanhala
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Antti Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Ville E Korhonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Mitja I Kurki
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland.,Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, and Stanley Center for Psychiatric Research, Broad Institute for Harvard and MIT, Boston, Massachusetts
| | | | | | - Ossi Nerg
- Neurology of NeuroCenter, KUH and UEF, Kuopio, Finland
| | | | - Anne M Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Jonna Perälä
- Department Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Turku University Hospital and University of Turku, Turku, Finland
| | - Jaana Suvisaari
- Department Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Social Psychiatry, School of Public Health, University of Tampere, Tampere, Finland
| | - Soili M Lehto
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Psychiatry and Clinical Research Centre, UEF, Kuopio Finland
| | | | | | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
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Yang F, Ma Q, Liu J, Ma B, Guo M, Liu F, Li J, Wang Z, Liu M. Prevalence and major risk factors of type 2 diabetes mellitus among adult psychiatric inpatients from 2005 to 2018 in Beijing, China: a longitudinal observational study. BMJ Open Diabetes Res Care 2020; 8:e000996. [PMID: 32139600 PMCID: PMC7059541 DOI: 10.1136/bmjdrc-2019-000996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We aim to investigate the prevalence, trends, and major risk factors of type 2 diabetes mellitus (T2DM) among adult psychiatric inpatients in Beijing, China. RESEARCH DESIGN AND METHODS We did a longitudinal observational study using data from the Beijing Municipal Commission of Health and Family Planning Information Center, including 157 570 adult psychiatric inpatients in 19 specialized psychiatric hospitals from 2005 to 2018 in Beijing. Data on demographic characteristics and antipsychotic medication use were obtained from electronic health records. Schizophrenia, T2DM, and comorbidities were defined according to the International Classification of Diseases, 10th revision codes of discharge diagnosis. The overall prevalence of T2DM in adult psychiatric inpatients was calculated, and the annual prevalence of T2DM was calculated and adjusted to the overall participant population. Univariate and multivariate logistic regression analyses were performed to obtain crude ORs and adjusted ORs (aORs) on the risk of T2DM in patients with different demographic characteristics, schizophrenia, antipsychotic medication use, and different comorbidities. Age-specific prevalence of T2DM under a stratification of schizophrenia or other psychiatric disorders was calculated in the subgroup analysis. RESULTS Out of 157 570 adult inpatients, 16 939 had T2DM, with a prevalence of 10.75% (95% CI 10.60% to 10.90%). The prevalence was 11.63% (95% CI 11.37% to 11.88%) among patients with schizophrenia and 10.17% (95% CI 9.98% to 10.37%) among patients with other psychiatric disorders. During 2005-2018, the prevalence of T2DM in adult patients increased over the years, from an adjusted prevalence of 5.20% in 2005, to 10.98% in 2010, 12.50% in 2015, and 12.71% in 2018. Results from the multivariate analysis showed that increasing age, diagnosis of schizophrenia (aOR=1.23, 95% CI 1.18 to 1.29), and comorbidities of hypertension (aOR=3.09, 95% CI 2.97 to 3.22), lipid disorders (aOR=1.95, 95% CI 1.88 to 2.04), and fatty liver (aOR=1.93, 95% CI 1.84 to 2.03) were major risk factors of T2DM in adult psychiatric inpatients. CONCLUSIONS The prevalence of T2DM was high among adult psychiatric inpatients in Beijing, China. Elderly patients, those with schizophrenia, and those with hypertension, lipid disorders, and fatty liver had higher prevalence of T2DM. Prevention and treatment of T2DM are of utmost relevance in hospitalized psychiatric patients.
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Affiliation(s)
- Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Qiuyue Ma
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Botao Ma
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Moning Guo
- Beijing Municipal Commission of Health and Family Planning Information Center, Beijing Municipal Commission of Health and Family Planning Policy Research Center, Beijing, China
| | - Fangchao Liu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Juan Li
- Beijing Geriatric Hospital, Beijing, China
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
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Sarker G, Litwan K, Kastli R, Peleg-Raibstein D. Maternal overnutrition during critical developmental periods leads to different health adversities in the offspring: relevance of obesity, addiction and schizophrenia. Sci Rep 2019; 9:17322. [PMID: 31754139 PMCID: PMC6872534 DOI: 10.1038/s41598-019-53652-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
Maternal overnutrition during sensitive periods of early development increases the risk for obesity and neuropsychiatric disorders later in life. However, it still remains unclear during which phases of early development the offspring is more vulnerable. Here, we investigate the effects of maternal high-fat diet (MHFD) at different stages of pre- or postnatal development and characterize the behavioral, neurochemical and metabolic phenotypes. We observe that MHFD exposure at pre-conception has no deleterious effects on the behavioral and metabolic state of the offspring. Late gestational HFD exposure leads to more prominent addictive-like behaviors with reduced striatal dopamine levels compared to early gestational HFD. Conversely, offspring exposed to MHFD during lactation display the metabolic syndrome and schizophrenia-like phenotype. The latter, is manifested by impaired sensory motor gating, and latent inhibition as well as enhanced sensitivity to amphetamine. These effects are accompanied by higher striatal dopamine levels. Together, our data suggest that MHFD exposure during specific stages of development leads to distinct neuropathological alterations that determine the severity and nature of poor health outcome in adulthood, which may provide insight in identifying effective strategies for early intervention.
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Affiliation(s)
- Gitalee Sarker
- Department of Health Sciences and Technology, ETH Zurich, Schwerzenbach, 8603, Switzerland.,Department of Physiology, Anatomy and Genetics University of Oxford, Sherrington Building, Parks Road, OX1 3PT, Oxford, United Kingdom
| | - Kathrin Litwan
- Department of Health Sciences and Technology, ETH Zurich, Schwerzenbach, 8603, Switzerland
| | - Rahel Kastli
- Department of Health Sciences and Technology, ETH Zurich, Schwerzenbach, 8603, Switzerland
| | - Daria Peleg-Raibstein
- Department of Health Sciences and Technology, ETH Zurich, Schwerzenbach, 8603, Switzerland.
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Prevalence and Associated Factors of Metabolic Syndrome among Patients with Severe Mental Illness Attending a Tertiary Hospital in Southwest Uganda. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1096201. [PMID: 31815121 PMCID: PMC6877961 DOI: 10.1155/2019/1096201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/19/2019] [Indexed: 12/14/2022]
Abstract
Globally, the prevalence of metabolic syndrome (MetS) and its components which are the major cardiovascular disease (CVD) risk factors, is higher among patients with severe mental illness (SMI) compared to the general population. This is mainly due to the deleterious lifestyles characterized by physical inactivity, excessive alcohol consumption, smoking, and unhealthy diets common among patients with SMI as well as due to cardiometabolic effects of psychotropic medications. Despite these conditions being highly prevalent among patients with SMI, little attention is given to these conditions during routine reviews in the mental health clinics in most low-income countries including Uganda. The main objective of this study was to determine the prevalence and associated factors of MetS among patients with SMI at Mbarara Regional Referral Hospital (MRRH), a tertiary hospital in southwestern Uganda. Through a cross-sectional study at the mental health clinic of the hospital, we recruited 304 patients with SMI and evaluated them for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We defined the prevalence of MetS as the proportion of patients meeting the NCEP ATP III criteria. We used logistic regression to evaluate associations between MetS and independent variables. We included a total of 302 (44.37% male, 55.63% female) patients with a diagnosis of SMI in the analysis. The prevalence of MetS was 23.51% (95% CI 18.84–28.71). At multivariable logistic regression, age >40 years and long duration of mental illness (>10 years) were significantly associated with MetS. The prevalence of MetS is high among patients with psychiatric disorders, and thus metabolic screening, especially among the high-risk groups, is critical.
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Assessment of Long Term Metabolic Effects of Atypical Antipsychotics in Schizophrenia Patients. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2019. [DOI: 10.2478/rjdnmd-2019-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims. Patients with schizophrenia have a shorter life expectancy than normal population partially due to the metabolic side effects of antipsychotic treatment. The aim of this study is to evaluate the long-term evolution of the metabolic syndrome in chronic schizophrenia patients on fixed second generation antipsychotics (SGA).
Material and method. The components of metabolic syndrome were evaluated repeatedly in a minimum 6 months and maximum 2 years follow-up period. The presence of metabolic syndrome (MetS) and metabolic risk scores (cMetS) according to National Cholesterol Education Program Adult Treatment Panel III were calculated and compared in time. In the prevalence, incidence and normalization logistic regression studies included all the known risk factors together with the follow-up period. Finally, all these rates were compared depending on the type of SGA.
Results. Only cMetS, waist circumference and diastolic blood pressure presented significant increase in the follow-up period which was in average 385.5 days. The prevalence of MetS at base-line was 39.4%, which increased to 48.5% after the follow-up period. The calculated incidence of 30% was associated with a 23.1% rate of normalization. Logistic regression studies revealed as independent risk factors the age and base-line cMetS/weight for incidence and for normalization. In the aripiprazole group the normalization rate exceeded the incidence rate (33.3% vs 20%).
Conclusions. The results emphasize the highly dynamic character of the metabolic syndrome even in chronic schizophrenia patients with fixed SGA regimen. The normalization of MetS is a possibility that should not ignored. The age and weight continue to remain independent risk factors, thus close monitoring in elderly and strict weight control plan are necessary. Aripiprazole showed better safety profile, but more extensive studies are required for definitive conclusions.
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 862] [Impact Index Per Article: 143.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Tay YH, Lee J. The relationship between serum adiponectin levels, cardiometabolic indices and metabolic syndrome in schizophrenia. Asian J Psychiatr 2019; 43:1-6. [PMID: 31059867 DOI: 10.1016/j.ajp.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adiponectin is a hormone secreted by adipose tissues that is thought to influence lipid and glucose metabolism, and the development of metabolic derangements, including metabolic syndrome (MetS), in schizophrenia. We aim to determine the serum adiponectin levels in Chinese patients with schizophrenia, and explore the relationship between adiponectin levels and metabolic parameters, including MetS and its components. We hypothesized that serum adiponectin levels are similar in schizophrenia patients and controls, but decreased amongst patients on atypical antipsychotics. METHODS 81 patients and 81 controls were recruited. Anthropometric parameters and fasted blood samples for metabolic measurements were obtained. Serum adiponectin levels were measured using Bioplex assays. RESULTS There was no difference in median adiponectin levels between schizophrenia patients and controls. Those taking typical antipsychotics alone had lower median adiponectin levels than those on mixed typical and atypical antipsychotics. Serum adiponectin level, controlled for age, gender and body mass index, was positively correlated with high-density lipoprotein cholesterol, and negatively correlated with diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels in schizophrenia patients. Patients with MetS had lower median adiponectin levels than those without MetS, and serum adiponectin levels decreased as the number of MetS components increased. After adjusting for variables thought to influence MetS, our logistic regression model did not reveal any significant association between adiponectin levels and MetS in schizophrenia patients. CONCLUSION Our findings highlight the need for more studies focusing on serum adiponectin level and its relationship with MetS in schizophrenia, particularly in those taking typical antipsychotics.
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Affiliation(s)
- Yi Hang Tay
- Department of Forensic Psychiatry, Institute of Mental Health, Singapore.
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; North Region & Department of Psychosis, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Vedal TSJ, Steen NE, Birkeland KI, Dieset I, Reponen EJ, Laskemoen JF, Rødevand L, Melle I, Andreassen OA, Molden E, Jönsson EG. Adipokine levels are associated with insulin resistance in antipsychotics users independently of BMI. Psychoneuroendocrinology 2019; 103:87-95. [PMID: 30659986 DOI: 10.1016/j.psyneuen.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/24/2018] [Accepted: 01/03/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prevalence of obesity, metabolic syndrome and type 2 diabetes mellitus is increased among patients with severe mental disorders, and particularly use of second generation antipsychotic drugs is associated with metabolic side effects. Antipsychotics have been found to alter levels of adipokines which regulate insulin sensitivity, but their role in antipsychotic-associated insulin resistance is not established, and it is unclear whether adipokines affect insulin resistance independently of body mass index (BMI). METHODS We included 1050 patients with severe mental disorders and 112 healthy controls aged 18-65 years from the Oslo area, Norway. Clinical variables, BMI and use of medication were assessed, fasting blood samples were obtained for calculation of the leptin/adiponectin ratio (L/A ratio) and estimate of insulin resistance using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Case-control analyses were followed by mediation analyses to evaluate the possible direct effect of antipsychotics on HOMA-IR and indirect effect mediated via the L/A ratio. This was performed both with and without adjustment for BMI, in the total sample and in an antipsychotic monotherapy subsample (N = 387). RESULTS BMI, L/A ratio and HOMA-IR were significantly higher in patients than controls (p < 0.001-p = 0.01). There was a significant direct effect from use of antipsychotics in general on HOMA-IR both without (b = 0.03, p = 0.007) and with adjustment for BMI (b = 0.03, p = 0.013), as well as a significant mediating effect via L/A ratio both without (b = 0.03, p < 0.001) and with adjustment for BMI (b = 0.01, p = 0.041). Use of olanzapine (b = 0.03, p < 0.001) or aripiprazole (b = 0.04, p < 0.001) in monotherapy showed significant effects on HOMA-IR mediated via L/A ratio. CONCLUSIONS The study suggests that use of antipsychotics may alter adipokine levels, and that increased L/A ratio may play a role in the development of insulin resistance associated with use of antipsychotics also independently of BMI.
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Affiliation(s)
- Trude S Jahr Vedal
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
| | - Nils Eiel Steen
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Kåre I Birkeland
- Department of Transplantation Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ingrid Dieset
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Elina J Reponen
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Jannicke F Laskemoen
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Linn Rødevand
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik G Jönsson
- NORMENT & K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway; Department of Clinical Neuroscience, Center for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
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Ng-Mak D, Rajagopalan K. Examining quality of care for individuals treated for mental health using the HEDIS mental health quality measures. Curr Med Res Opin 2019; 35:87-95. [PMID: 30286663 DOI: 10.1080/03007995.2018.1532883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: This descriptive study examined the quality of care received by individuals with serious mental illness observed in clinical care using established Healthcare Effectiveness Data and Information Set (HEDIS) measures for individuals with serious mental illness.Methods: Administrative claims (Medicaid, Medicare, and commercial) from a national health and well-being company were used to identify adults with schizophrenia or bipolar disorder. Performance rates for five HEDIS mental health quality measures were computed. Sub-group analyses examined each HEDIS measure by those who were medication adherent vs non-adherent, and by typical vs atypical antipsychotics.Results: Eighty-nine percent of the Medicaid population received a diabetes screening (vs 79% for national benchmark Medicaid rates), 81% (vs 69%) received monitoring for diabetes, 88% (vs 79%) received monitoring for cardiovascular disease, 63% (vs 60%) were adherent with antipsychotic medication, and 34% (vs 61%) had a follow-up visit with a mental health practitioner within 30 days of a discharge. The rates for individuals with Medicare coverage were similar or marginally higher than those reported for those with Medicaid coverage, while rates for the commercially insured population were lower than the other groups.Conclusions: Most (>65%) individuals with serious mental illness received the recommended screening and monitoring for diabetes and cardiovascular disease. Barriers to and reasons for lack of follow-up should be investigated to guide future interventions to improve follow-up after hospitalization for individuals with serious mental illness.
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Affiliation(s)
- Daisy Ng-Mak
- Global Health Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Krithika Rajagopalan
- Global Health Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Soontornniyomkij V, Lee EE, Jin H, Martin AS, Daly RE, Liu J, Tu XM, Eyler LT, Jeste DV. Clinical Correlates of Insulin Resistance in Chronic Schizophrenia: Relationship to Negative Symptoms. Front Psychiatry 2019; 10:251. [PMID: 31065243 PMCID: PMC6488983 DOI: 10.3389/fpsyt.2019.00251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
Higher prevalence of physical comorbidity and premature mortality in persons with schizophrenia (PwS) results primarily from heightened cardiovascular and metabolic risks. The literature suggests that insulin resistance precedes the development of obesity, smoking, and use of antipsychotic medications, although these likely play a compounding role later in the course of the disorder. It is thus important to discover the clinical characteristics of PwS with high insulin resistance, as these individuals may represent an etiopathologically distinct subgroup with a distinct course and treatment needs. We conducted a cross-sectional study and compared insulin resistance between 145 PwS and 140 nonpsychiatric comparison (NC) participants, similar in age, sex, and race distribution. In addition, we examined correlates of insulin resistance in PwS. As expected, PwS had higher levels of insulin resistance [Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)] and body mass index (BMI) compared to the NC participants. HOMA-IR in the PwS was most associated with negative symptoms, BMI, and non-White race/ethnicity. The mechanistic relationships between insulin resistance and negative symptoms in schizophrenia patients warrant further investigation, and future studies should examine outcomes of PwS with this cluster of physical and mental symptoms and determine how management of insulin resistance might improve health of these individuals.
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Affiliation(s)
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Hua Jin
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Averria Sirkin Martin
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Rebecca E Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Jinyuan Liu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Xin M Tu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Lisa Todd Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,Center for Healthy Aging, University of California San Diego, La Jolla, CA, United States.,Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
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47
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de Nijs J, Schnack HG, Koevoets MGJC, Kubota M, Kahn RS, van Haren NEM, Cahn W. Reward-related brain structures are smaller in patients with schizophrenia and comorbid metabolic syndrome. Acta Psychiatr Scand 2018; 138:581-590. [PMID: 30264457 DOI: 10.1111/acps.12955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Metabolic syndrome (MS) is highly prevalent in schizophrenia and often a consequence of unhealthy behaviour. Reward-related brain areas might be associated with MS, since they play a major role in regulating health behaviour. This study examined the relationship between MS and brain volumes related to the reward system in schizophrenia. METHOD We included patients with schizophrenia, with MS (MS+; n = 23), patients with schizophrenia, without MS (MS-; n = 48), and healthy controls (n = 54). Global brain volumes and volumes of (sub)cortical areas, part of the reward circuit, were compared between patients and controls. In case of a significant brain volume difference between patients and controls, the impact of MS in schizophrenia was examined. RESULTS Patients had smaller total brain (TB; P = 0.001), GM (P = 0.010), larger ventricles (P = 0.026), and smaller reward circuit volume (P < 0.001) than controls. MS+ had smaller TB (P = 0.017), GM (P = 0.008), larger ventricles (P = 0.015), and smaller reward circuit volume (P = 0.002) than MS-. MS+ had smaller orbitofrontal cortex (OFC; P = 0.002) and insula volumes (P = 0.005) and smaller OFC (P = 0.008) and insula cortical surface area (P = 0.025) compared to MS-. CONCLUSION In schizophrenia, structural brain volume reductions in areas of the reward circuitry appear to be related to comorbid MS.
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Affiliation(s)
- J de Nijs
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - H G Schnack
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M G J C Koevoets
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M Kubota
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - R S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
| | - N E M van Haren
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W Cahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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48
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Owusu–Ansah A, Berko Panyin A, Obirikorang C, Agyare C, Acheampong E, Kwofie S, Odame Anto E, Nsenbah Batu E. Metabolic Syndrome among Schizophrenic Patients: A Comparative Cross-Sectional Study in the Middle Belt of Ghana. SCHIZOPHRENIA RESEARCH AND TREATMENT 2018; 2018:6542983. [PMID: 30050695 PMCID: PMC6046121 DOI: 10.1155/2018/6542983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 01/05/2023]
Abstract
The study determined the prevalence of MetS in patients with schizophrenia at the Psychiatric Unit of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. This comparative cross-sectional study recruited 348 schizophrenic patients comprising 236 antipsychotic-treated and 112 newly diagnosed treatment-naïve patients. The MetS prevalence was assessed based on World Health Organization (WHO), International Diabetes Federation (IDF), and the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) criteria. The overall prevalence of MetS was 14.1%, 20.4%, and 23.6% using NCEP ATP III, WHO, and IDF criteria, respectively, compared to 7.8%, 3.9%, and 2.2% reported in the general Ghanaian population. The prevalence was significantly higher among treated psychiatric patients compared to treatment-naïve group based on NCEP ATP III (17.8% versus 6.2%; p = 0.0001), WHO (26.2% versus 8.0%; p < 0.0001), and IDF (30.3% versus 10.0%; p < 0.0001). MetS was prevalent among patients on atypical antipsychotics compared to typical antipsychotics irrespective of the criteria used (i.e., 17.1% versus 11.1% for NCEP ATP III; 29.5% versus 25.9% for WHO; and 44.3% versus 18.5% for IDF). Using logistic regression model, obesity, raised fasting blood sugar, raised total cholesterol, and decreased high density lipoprotein were observed to be significant predictors of MetS (p<0.05).The study found high prevalence of MetS in Ghanaians with schizophrenia and higher prevalence rate of MetS associated with monotherapy. Regular monitoring of cardiometabolic parameters should be an important therapeutic objective in the management of these patients.
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Affiliation(s)
- Angela Owusu–Ansah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Anto Berko Panyin
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Christian Agyare
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, WA, Australia
| | - Simon Kwofie
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Enoch Odame Anto
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, WA, Australia
| | - Emmanuella Nsenbah Batu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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49
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Jeong SH, Lee NY, Kim SH, Chung IW, Youn T, Kang UG, Ahn YM, You HY, Kim YS. Long-Term Evolution of Metabolic Status in Patients with Schizophrenia Stably Maintained on Second-Generation Antipsychotics. Psychiatry Investig 2018; 15:628-637. [PMID: 29940717 PMCID: PMC6018140 DOI: 10.30773/pi.2018.01.18.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/18/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Second-generation antipsychotics (SGAs) increase the risk of metabolic syndrome (MetS). Despite the risk of MetS, SGAs may have to be continued with change in some patients. The aim of this study was to trace the evolution of MetS in these patients. METHODS Patients with schizophrenia who had been maintained on a fixed SGA regimen for more than a year were followed-up without changing the regimen. Metabolic indicators were evaluated at baseline and at follow-up. Prevalence, incidence and spontaneous normalization rate of MetS were estimated. Risk factors that might have influenced the evolution were scrutinized. RESULTS A total of 151 subjects were included. During the mean observation period of 389.9±162.4 days, the prevalence of MetS was increased from 35.1 to 45.0%. The incidence rate was 29.6%, while the normalization rate was 26.4%, risk factors affecting incidence were age (OR=1.09, 95% CI: 1.03-1.17), baseline continuous values of metabolic syndrome risk scores (cMetS, OR=1.77, 95% CI:1.29-2.55) and baseline body weight (OR=1.06, 95% CI: 1.01-1.13). Normalization was influenced by age (OR=0.74, 95% CI: 0.57-0.89) and baseline body weight (OR=0.85, 95% CI: 0.72-0.95). CONCLUSION The prevalence of MetS steadily increased with the continuous use of SGAs. However, individual difference was extensive and about a quarter of the patients were able to recover naturally without specific measurements.
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Affiliation(s)
- Seong Hoon Jeong
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Republic of Korea
| | - Nam Young Lee
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Se Hyun Kim
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - In Won Chung
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Tak Youn
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Ung Gu Kang
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Min Ahn
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han Young You
- College of Nursing Science, Ewha Woman's University, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
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50
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Pinto JAF, de Freitas PHB, Nunes FDD, Granjeiro PA, dos Santos LL, Machado RM. Prevalence of polymorphisms in the ANKK1, DRD2, DRD3 genes and metabolic syndrome in refractory schizophrenia. Rev Lat Am Enfermagem 2018; 26:e2983. [PMID: 29791666 PMCID: PMC5969827 DOI: 10.1590/1518-8345.2222.2983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/03/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE to estimate the prevalence of TaqIA, -141C and rs6280 polymorphisms of the ANKK1, DRD2 and DRD3 genes and evaluate their association with the occurrence of metabolic syndrome in patients with refractory schizophrenia. METHOD cross-sectional study conducted in the Extended Western Region of Minas Gerais, with refractory schizophrenic patients using the antipsychotic clozapine. Sociodemographic, clinical, anthropometric, biochemical and genetic data were collected. Univariate analysis of the data was performed. RESULTS seventy-two patients participated in the study and the occurrence of Metabolic Syndrome was observed in 47.2% of them. There was no association between Metabolic Syndrome and the studied polymorphisms. There was a statistically significant difference in the low HDL parameter with homozygous genotype for the C allele of the -141C polymorphism of the DRD2 gene. CONCLUSION a high prevalence of MS was evidenced. The -141C polymorphism was associated with low HDL. Genetic analysis and identification of metabolic alterations in this group of patients can guide drug treatment and provide a better quality of life.
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Affiliation(s)
| | | | - Fernanda Daniela Dorneles Nunes
- Graduated, MSc in Nursing, Graduate Program in Nursing,
Universidade Federal de São João Del Rei, Divinópolis, MG, Brazil, Scientific
Initiation Scholarship
| | - Paulo Afonso Granjeiro
- PhD, Functional and Molecular Biology, Adjunct Professor, Pharmacy,
Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil
| | - Luciana Lara dos Santos
- PhD, Genetic, Adjunct Professor, Biological Sciences, Universidade
Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil
| | - Richardson Miranda Machado
- PhD, Psychiatry, Adjunct Professor, Nursing, Universidade Federal
de São João Del Rei, Divinópolis, Minas Gerais, Brazil
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