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ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S77-S110. [PMID: 38078584 PMCID: PMC10725816 DOI: 10.2337/dc24-s005] [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] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Shamsutdinova D, Das-Munshi J, Ashworth M, Roberts A, Stahl D. Predicting type 2 diabetes prevalence for people with severe mental illness in a multi-ethnic East London population. Int J Med Inform 2023; 172:105019. [PMID: 36787689 DOI: 10.1016/j.ijmedinf.2023.105019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND AIMS Prevalence of type two diabetes mellitus (T2DM) in people with severe mental illness (SMI) is 2-3 times higher than in general population. Predictive modelling has advanced greatly in the past decade, and it is important to apply cutting-edge methods to vulnerable groups. However, few T2DM prediction models account for the presence of mental illness, and none seemed to have been developed specifically for people with SMI. Therefore, we aimed to develop and internally validate a T2DM prevalence model for people with SMI. METHODS We utilised a large cross-sectional sample representative of a multi-ethnic population from London (674,000 adults); 10,159 people with SMI formed our analytical sample (1,513 T2DM cases). We fitted a linear logistic regression and XGBoost as stand-alone models and as a stacked ensemble. Age, sex, body mass index, ethnicity, area-based deprivation, past hypertension, cardiovascular diseases, prescribed antipsychotics, and SMI illness were the predictors. RESULTS Logistic regression performed well while detecting T2DM presence for people with SMI: area under the receiver operator curve (ROC-AUC) was 0.83 (95 % CI 0.79-0.87). XGBoost and LR-XGBoost ensemble performed equally well, ROC-AUC 0.83 (95 % CI 0.79-0.87), indicating a negligible contribution of non-linear terms to predictive power. Ethnicity was the most important predictor after age. We demonstrated how the derived models can be utilised and estimated a 2.14 % (95 %CI 2.03 %-2.24 %) increase in T2DM prevalence in East London SMI population in 20 years' time, driven by the projected demographic changes. CONCLUSIONS Primary care data, the setting where prediction models could be most fruitfully used, provide enough information for well-performing T2DM prevalence models for people with SMI. We demonstrated how thorough internal cross-validation of an ensemble of a linear and machine-learning model can quantify the predictive value of non-linearity in the data.
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Affiliation(s)
- Diana Shamsutdinova
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom; South London and Maudsley NHS Trust, London, United Kingdom
| | - Mark Ashworth
- ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom
| | - Angus Roberts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Young-Hyman D, Gabbay RA, on behalf of the American Diabetes Association. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S68-S96. [PMID: 36507648 PMCID: PMC9810478 DOI: 10.2337/dc23-s005] [Citation(s) in RCA: 138] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Ouyang F, He J, Cheng X, Zhou W, Xiao S, Fang J. Antipsychotic-Related Risks of Type 2 Diabetes Mellitus in Enrollees With Schizophrenia in the National Basic Public Health Service Program in Hunan Province, China. Front Psychiatry 2022; 13:754775. [PMID: 35280179 PMCID: PMC8909132 DOI: 10.3389/fpsyt.2022.754775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antipsychotics contribute to the development of type 2 diabetes mellitus (T2DM) in individuals with schizophrenia. However, the extent of the relationship between antipsychotic use and T2DM varies in different settings, and the magnitude of the drug-specific effects fluctuates widely. This study aimed to explore the association of T2DM with antipsychotic use among enrollees with schizophrenia in China's National Basic Public Health Service Program (NBPHSP) and the drug-specific relationship with T2DM among patients receiving antipsychotic monotherapy. METHODS We recruited diabetes-free patients with schizophrenia who were enrolled in the NBPHSP of Hunan Province from October 2009 to December 2018. The participants were classified into the following three groups: regular antipsychotic use, intermittent antipsychotic use, and antipsychotic-free groups. The patients were followed up until they received a T2DM diagnosis or until April 2019. Cox regression models were constructed to calculate the overall and drug-specific hazard ratios (HRs) to determine the antipsychotic-T2DM relationship. Interactive and subgroup analyses were performed to assess the heterogeneity of the effects across subgroups. RESULTS A total of 122,064 NBPHSP enrollees with schizophrenia were followed up for 1,507,829 cumulative person-years, and 2,313 (1.89%) patients developed T2DM. Patients who regularly and intermittently used antipsychotics had 117% (HR: 2.17, 95% CI: 1.83-2.57) and 53% (HR: 1.53, 95% CI: 1.23-1.90) higher risks of developing T2DM than antipsychotic-free patients, respectively. Regarding monotherapy, the T2DM risk increased by 66, 80, 62, and 64% after the regular use of clozapine, risperidone, chlorpromazine, and perphenazine, respectively. In addition, the antipsychotic-related risk of T2DM decreased as the patient's baseline body mass index, and baseline fasting plasma glucose level, as well as the dietary proportion of animal products, increased. CONCLUSION Antipsychotics, especially clozapine, risperidone, chlorpromazine, and perphenazine, increased the T2DM risk among NBPHSP enrollees with schizophrenia. Mental health officers should accurately identify enrollees at a high risk of T2DM and take appropriate preventive measures to reduce the incidence of T2DM among patients with schizophrenia.
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Affiliation(s)
- Feiyun Ouyang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jun He
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Junqun Fang
- Department of Health Management, Maternal and Child Health Hospital of Hunan Province, Changsha, China
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5
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S60-S82. [PMID: 34964866 DOI: 10.2337/dc22-s005] [Citation(s) in RCA: 127] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Linnaranta O, Trontti KT, Honkanen J, Hovatta I, Keinänen J, Suvisaari J. Peripheral metabolic state and immune system in first-episode psychosis - A gene expression study with a prospective one-year follow-up. J Psychiatr Res 2021; 137:383-392. [PMID: 33765450 DOI: 10.1016/j.jpsychires.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
he excess availability of glucose and lipids can also have an impact on the dynamics of activation and regulation of peripheral immune cellsWe aimed at understanding the correlations between peripheral metabolic state and immune system during the first year in first-episode psychosis (FEP). Patients with FEP (n = 67) and matched controls (n = 38), aged 18-40 years, were met at baseline, 2 and 12 months. Fasting peripheral blood samples were collected. We applied the NanoString nCounter in-solution hybridization technology to determine gene expression levels of 178 candidate genes reflecting activation of the immune system. Serum triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol and insulin and plasma glucose (fP-Gluc) were measured. We applied Ingenuity Pathway Analysis (IPA) to visualize enrichment of genes to functional classes. Strength of positive or negative regulation of the disease and functional pathways was deduced from IPA activation Z-score at the three evaluation points. We correlated gene expression with plasma glucose, triglycerids and HDL and LDL, and used hierarchical clustering of the pairwise correlations to identify groups of genes with similar correlation patterns with metabolic markers. In patients, initially, genes associated with the innate immune system response pathways were upregulated, which decreased by 12 months. Furthermore, genes associated with apoptosis and T cell death were downregulated, and genes associated with lipid metabolism were increasingly downregulated by 12 months. The immune activation was thus an acute phase during illness onset. At baseline, after controlling for multiple testing, 31/178 genes correlated positively with fasting glucose levels, and 54/178 genes negatively with triglycerides in patients only. The gene clusters showed patterns of correlations with metabolic markers over time. The results suggest a functional link between peripheral immune system and metabolic state in FEP. Metabolic factors may have had an influence on the initial activation of the innate immune system. Future work is necessary to understand the role of metabolic state in the regulation of immune response in the early phases of psychosis.
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Affiliation(s)
- Outi Linnaranta
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Centre for Sleep and Biological Rhythms, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, H4H 1R3, Montreal, QC, Canada; Department of Public Health Solutions, Mental Health Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Kalevi T Trontti
- Sleep Well Research Program, Faculty of Medicine, P.O. Box 21, FI-00014, University of Helsinki, Finland; Neuroscience Center, Helsinki Institute of Life Science HiLIFE, P.O. Box 21, FI-00014, University of Helsinki, Finland
| | - Jarno Honkanen
- Research Program for Clinical and Molecular Metabolism, P.O. Box 63, FI-00014, University of Helsinki, Helsinki, Finland
| | - Iiris Hovatta
- Sleep Well Research Program, Faculty of Medicine, P.O. Box 21, FI-00014, University of Helsinki, Finland; Neuroscience Center, Helsinki Institute of Life Science HiLIFE, P.O. Box 21, FI-00014, University of Helsinki, Finland; Department of Psychology and Logopedics, Medicum, P.O. Box 21, FI-00014, University of Helsinki, Finland
| | - Jaakko Keinänen
- Department of Public Health Solutions, Mental Health Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
| | - Jaana Suvisaari
- Department of Public Health Solutions, Mental Health Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S53-S72. [PMID: 33298416 DOI: 10.2337/dc21-s005] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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8
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Bergantin LB. A link among schizophrenia, diabetes, and asthma: Role of Ca2 +/cAMP signaling. Brain Circ 2020; 6:145-151. [PMID: 33210037 PMCID: PMC7646390 DOI: 10.4103/bc.bc_66_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 01/18/2023] Open
Abstract
Asthma has been associated with an increased risk for developing schizophrenia. In addition, schizophrenia has been associated with an increased risk for developing type 2 diabetes mellitus, resulting in an elevated cardiovascular risk and in a limited life expectancy. It is well discussed that dysregulations related to Ca2+ signaling could link these diseases, in addition to cAMP signaling pathways. Thus, revealing this interplay among schizophrenia, diabetes, and asthma may provide novel insights into the pathogenesis of these diseases. Publications involving Ca2+ and cAMP signaling pathways, schizophrenia, diabetes, and asthma (alone or combined) were collected by searching PubMed and EMBASE. Both Ca2+ and cAMP signaling pathways (Ca2+/cAMP signaling) control the release of neurotransmitters and hormones, in addition to airway smooth muscle contractility, then dysregulations of these cellular processes may be involved in these diseases. Taking into consideration, the experience of our group in this field, this narrative review debated the involvement of Ca2+/cAMP signaling in this link among schizophrenia, diabetes, and asthma, including its pharmacological implications.
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Affiliation(s)
- Leandro Bueno Bergantin
- Department of Pharmacology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Korpela H, Miettunen J, Rautio N, Isohanni M, Järvelin MR, Jääskeläinen E, Auvinen J, Keinänen-Kiukaanniemi S, Nordström T, Seppälä J. Early environmental factors and somatic comorbidity in schizophrenia and nonschizophrenic psychoses: A 50-year follow-up of the Northern Finland Birth Cohort 1966. Eur Psychiatry 2020; 63:e24. [PMID: 32146919 PMCID: PMC7315879 DOI: 10.1192/j.eurpsy.2020.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background. We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years. Methods. The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses. Results. When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis. Conclusions. Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.
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Affiliation(s)
- Hanna Korpela
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Cancer Research and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Nina Rautio
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Matti Isohanni
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Center for Environment & Health, School of Public Health, Imperial College London, London, United Kindom.,Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Tanja Nordström
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jussi Seppälä
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Department of Psychiatry and Substance Use, South Karelia Social and Health Care District, Lappeenranta, Finland
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Li Y, Wang K, Zhang P, Huang J, Liu Y, Wang Z, Lu Y, Tan S, Yang F, Tan Y. Pyrosequencing analysis of IRS1 methylation levels in schizophrenia with tardive dyskinesia. Mol Med Rep 2020; 21:1702-1708. [PMID: 32319643 PMCID: PMC7057828 DOI: 10.3892/mmr.2020.10984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/17/2020] [Indexed: 12/16/2022] Open
Abstract
Tardive dyskinesia (TD) is a serious side effect of certain antipsychotic medications that are used to treat schizophrenia (SCZ) and other mental illnesses. The methylation status of the insulin receptor substrate 1 (IRS1) gene is reportedly associated with SCZ; however, no study, to the best of the authors' knowledge, has focused on the quantitative DNA methylation levels of the IRS1 gene using pyrosequencing in SCZ with or without TD. The present study aimed to quantify DNA methylation levels of 4 CpG sites in the IRS1 gene using a Chinese sample including SCZ patients with TD and without TD (NTD) and healthy controls (HCs). The general linear model (GLM) was used to detect DNA methylation levels among the 3 proposed groups (TD vs. NTD vs. HC). Mean DNA methylation levels of 4 CpG sites demonstrated normal distribution. Pearson's correlation analysis did not reveal any significant correlations between the DNA methylation levels of the 4 CpG sites and the severity of SCZ. GLM revealed significant differences between the 3 groups for CpG site 1 and the average of the 4 CpG sites (P=0.0001 and P=0.0126, respectively). Furthermore, the TD, NTD and TD + NTD groups demonstrated lower methylation levels in CpG site 1 (P=0.0003, P<0.0001 and P<0.0001, respectively) and the average of 4 CpG sites (P=0.0176, P=0.0063 and P=0.003, respectively) compared with the HC group. The results revealed that both NTD and TD patients had significantly decreased DNA methylation levels compared with healthy controls, which indicated a significant association between the DNA methylation levels of the IRS1 gene with SCZ and TD.
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Affiliation(s)
- Yanli Li
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, P.R. China
| | - Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA
| | - Ping Zhang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, P.R. China
| | - Junchao Huang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, P.R. China
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, P.R. China
| | - Yongke Lu
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Shuping Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, P.R. China
| | - Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, P.R. China
| | - Yunlong Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, P.R. China
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43:S48-S65. [PMID: 31862748 DOI: 10.2337/dc20-s005] [Citation(s) in RCA: 213] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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12
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Walsan R, Mayne DJ, Feng X, Pai N, Bonney A. Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203905. [PMID: 31618833 PMCID: PMC6843457 DOI: 10.3390/ijerph16203905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
This study examined the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI)-type 2 diabetes (T2D) comorbidity in an Australian population using routinely collected clinical data. We hypothesised that neighbourhood socioeconomic disadvantage is positively associated with T2D comorbidity in SMI. The analysis considered 3816 individuals with an SMI living in the Illawarra and Shoalhaven regions of NSW, Australia, between 2010 and 2017. Multilevel logistic regression models accounting for suburb (neighbourhood) level clustering were used to assess the association between neighbourhood disadvantage and SMI -T2D comorbidity. Models were adjusted for age, sex, and country of birth. Compared with the most advantaged neighbourhoods, residents in the most disadvantaged neighbourhoods had 3.2 times greater odds of having SMI-T2D comorbidity even after controlling for confounding factors (OR 3.20, 95% CI 1.42-7.20). The analysis also revealed significant geographic variation in the distribution of SMI -T2D comorbidity in our sample (Median Odds Ratio = 1.35) Neighbourhood socioeconomic disadvantage accounted for approximately 17.3% of this geographic variation. These findings indicate a potentially important role for geographically targeted initiatives designed to enhance prevention and management of SMI-T2D comorbidity in disadvantaged communities.
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Affiliation(s)
- Ramya Walsan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
| | - Darren J Mayne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong 2502, Australia.
- The University of Sydney, School of Public Health, Sydney 2006, Australia.
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong 2522, Australia.
- School of Public Health and Community Medicine, University of New South Wales, Kennington 2031, Australia.
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong 2500, Australia.
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
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Prom MC. Facing Diabetes: A Guide for Psychiatric Providers. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190104-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42:S34-S45. [PMID: 30559230 DOI: 10.2337/dc19-s004] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Mamakou V, Hackinger S, Zengini E, Tsompanaki E, Marouli E, Serafetinidis I, Prins B, Karabela A, Glezou E, Southam L, Rayner NW, Kuchenbaecker K, Lamnissou K, Kontaxakis V, Dedoussis G, Gonidakis F, Thanopoulou A, Tentolouris N, Zeggini E. Combination therapy as a potential risk factor for the development of type 2 diabetes in patients with schizophrenia: the GOMAP study. BMC Psychiatry 2018; 18:249. [PMID: 30071838 PMCID: PMC6090901 DOI: 10.1186/s12888-018-1826-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Schizophrenia (SCZ) is associated with increased risk of type 2 diabetes (T2D). The potential diabetogenic effect of concomitant application of psychotropic treatment classes in patients with SCZ has not yet been evaluated. The overarching goal of the Genetic Overlap between Metabolic and Psychiatric disease (GOMAP) study is to assess the effect of pharmacological, anthropometric, lifestyle and clinical measurements, helping elucidate the mechanisms underlying the aetiology of T2D. METHODS The GOMAP case-control study (Genetic Overlap between Metabolic and Psychiatric disease) includes hospitalized patients with SCZ, some of whom have T2D. We enrolled 1653 patients with SCZ; 611 with T2D and 1042 patients without T2D. This is the first study of SCZ and T2D comorbidity at this scale in the Greek population. We retrieved detailed information on first- and second-generation antipsychotics (FGA, SGA), antidepressants and mood stabilizers, applied as monotherapy, 2-drug combination, or as 3- or more drug combination. We assessed the effects of psychotropic medication, body mass index, duration of schizophrenia, number of hospitalizations and physical activity on risk of T2D. Using logistic regression, we calculated crude and adjusted odds ratios (OR) to identify associations between demographic factors and the psychiatric medications. RESULTS Patients with SCZ on a combination of at least three different classes of psychiatric drugs had a higher risk of T2D [OR 1.81 (95% CI 1.22-2.69); p = 0.003] compared to FGA alone therapy, after adjustment for age, BMI, sex, duration of SCZ and number of hospitalizations. We did not find evidence for an association of SGA use or the combination of drugs belonging to two different classes of psychiatric medications with increased risk of T2D [1.27 (0.84-1.93), p = 0.259 and 0.98 (0.71-1.35), p = 0.885, respectively] compared to FGA use. CONCLUSIONS We find an increased risk of T2D in patients with SCZ who take a combination of at least three different psychotropic medication classes compared to patients whose medication consists only of one or two classes of drugs.
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Affiliation(s)
- Vasiliki Mamakou
- Medical School, National and Kapodistrian University Athens, 75 M. Assias Street, 115 27, Athens, Greece. .,Dromokaiteio Psychiatric Hospital, 124 61, Athens, Greece.
| | - Sophie Hackinger
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | - Eleni Zengini
- Dromokaiteio Psychiatric Hospital, 124 61 Athens, Greece ,0000 0004 1936 9262grid.11835.3eDepartment of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Evgenia Tsompanaki
- 0000 0001 2179 8267grid.16299.35School of Information Sciences and Technology, Department of Statistics, Athens University of Economics and Business, 10434 Athens, Greece
| | - Eirini Marouli
- 0000 0001 2171 1133grid.4868.2William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ, London, UK
| | - Ioannis Serafetinidis
- grid.414012.2Department of Gastroenterology, Gennimatas General Hospital, 11527 Athens, Greece
| | - Bram Prins
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | | | - Eirini Glezou
- Dromokaiteio Psychiatric Hospital, 124 61 Athens, Greece
| | - Lorraine Southam
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK ,0000 0004 1936 8948grid.4991.5Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Nigel W. Rayner
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK ,0000 0004 1936 8948grid.4991.5Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK ,0000 0004 0606 4224grid.470392.bOxford Centre for Diabetes Endocrinology and Metabolism, Oxford, UK
| | - Karoline Kuchenbaecker
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | - Klea Lamnissou
- 0000 0001 2155 0800grid.5216.0National and Kapodistrian University of Athens, Department of Biology, Athens, Panepistimioupolis, AnoIlisia, 15771 Athens, Greece
| | - Vassilis Kontaxakis
- 0000 0001 2155 0800grid.5216.0Early Psychosis Unit, 1st Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Dedoussis
- 0000 0004 0622 2843grid.15823.3dDepartment of Nutrition-Dietetics, Harokopio University, 17671 Athens, Greece
| | - Fragiskos Gonidakis
- 0000 0001 2155 0800grid.5216.01st Psychiatric Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Thanopoulou
- 0000 0001 2155 0800grid.5216.0Diabetes Centre, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, 11527 Athens, Greece
| | - Eleftheria Zeggini
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
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Keinänen J, Mantere O, Markkula N, Partti K, Perälä J, Saarni SI, Härkänen T, Suvisaari J. Mortality in people with psychotic disorders in Finland: A population-based 13-year follow-up study. Schizophr Res 2018; 192:113-118. [PMID: 28499768 DOI: 10.1016/j.schres.2017.04.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/21/2017] [Accepted: 04/30/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. METHODS In a nationally representative sample of Finns aged 30-70years (n=5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. RESULTS No people with affective psychoses (n=36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n=106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). CONCLUSIONS The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders.
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Affiliation(s)
- Jaakko Keinänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Outi Mantere
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montréal, QC H4H 1R3, Canada.
| | - Niina Markkula
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago, Chile.
| | - Krista Partti
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; University of Helsinki, Doctoral Program in Clinical Research, P.O. Box 700, FIN-00029 HUS, Finland.
| | - Jonna Perälä
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Samuli I Saarni
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Turku University Hospital and the University of Turku, P.O. Box 52, FIN-20521, Turku, Finland.
| | - Tommi Härkänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Health Monitoring Unit, P.O. Box 30, FIN-00271, Helsinki, Finland.
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland.
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3. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41:S28-S37. [PMID: 29222374 DOI: 10.2337/dc18-s003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Brostedt EM, Msghina M, Persson M, Wettermark B. Health care use, drug treatment and comorbidity in patients with schizophrenia or non-affective psychosis in Sweden: a cross-sectional study. BMC Psychiatry 2017; 17:416. [PMID: 29284436 PMCID: PMC5747108 DOI: 10.1186/s12888-017-1582-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study investigated the prevalence of schizophrenia (ICD-10 F 20) and of other non-affective psychosis (NAP, ICD-10 F 21 - F 29) in Sweden. It further assessed health care use, comorbidity and medication for these patient groups. Most studies either have a study population of patients with strictly defined schizophrenia or a psychosis population of which strict schizophrenia cases form a smaller set. The present study permits comparison of the two mutually exclusive patient groups using data at the individual level in the diagnosis of non-affective psychosis, use of health care, medical treatment and comorbidity by diagnosis or medical treatment. METHODS In 2012, data were extracted from a regional registry containing patient-level data on consultations, hospitalisations, diagnoses and dispensed drugs for the total population in the region of Stockholm (2.1 million inhabitants). The size of the total psychosis population was 18,769, of which 7284 had a diagnosis of schizophrenia. Crude prevalence rates and risk rates with 95% confidence intervals were calculated. RESULTS In 2012, the prevalence of schizophrenia and NAP was 3.5/1000 and 5.5/1000, respectively. Schizophrenia was most common among patients aged 50-59 years and NAP most common among patients aged 40-49 years. Schizophrenia patients used psychiatric health care more often than the NAP patients but less overall inpatient care (78.6 vs. 60.0%). The most prevalent comorbidities were substance abuse/dependence (7.9% in the schizophrenia group vs. 11.7% in the NAP group), hypertension (7.9 vs. 9.7%) and diabetes (6.9 vs. 4.8%). The parenteral form of long-acting injectable antipsychotics was more often dispensed to patients with schizophrenia (10 vs. 2%). CONCLUSIONS This study, analysing all diagnoses recorded in a large health region, confirmed prevalence rates found in previous studies. Schizophrenia patients use more psychiatric and less overall inpatient health care than NAP patients. Differences between the two patient groups in comorbidity and drug treatment were found. The registered rates of a substance abuse/dependence diagnosis were the most common comorbidity observed among the patients investigated. The observed differences between the schizophrenia and the NAP patients in health care consumption, comorbidity and drug treatment are relevant and warrant further studies.
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Affiliation(s)
- Erica M. Brostedt
- 0000 0001 2326 2191grid.425979.4Department of Healthcare Development, Public Health Care Services, Stockholm County Council, Box 6909, 102 39 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Medicine, Clinical Epidemiology Unit T2, Centre for Pharmacoepidemiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, 17176 Sweden
| | - Mussie Msghina
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Universitetssjukhuset, Huddinge, Karolinska Institutet, Stockholm, 141 86 Sweden
| | - Marie Persson
- 0000 0001 2326 2191grid.425979.4Pharmaceutical Unit, Public Health Care Services, Stockholm County Council, Box 17533, Stockholm, 11891 Sweden
| | - Björn Wettermark
- 0000 0001 2326 2191grid.425979.4Department of Healthcare Development, Public Health Care Services, Stockholm County Council, Box 6909, 102 39 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Medicine, Clinical Epidemiology Unit T2, Centre for Pharmacoepidemiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, 17176 Sweden
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Affiliation(s)
- Rajesh Ranganath
- Department of Computer Science, Princeton University, Princeton, NJ
| | - David M. Blei
- Departments of Computer Science and Statistics, Columbia University, New York, NY
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Eskelinen S, Sailas E, Joutsenniemi K, Holi M, Koskela TH, Suvisaari J. Multiple physical healthcare needs among outpatients with schizophrenia: findings from a health examination study. Nord J Psychiatry 2017; 71:448-454. [PMID: 28497707 DOI: 10.1080/08039488.2017.1319497] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the abundant literature on physical comorbidity, the full range of the concurrent somatic healthcare needs among individuals with schizophrenia has rarely been studied. AIMS This observational study aimed to assess the distressing somatic symptoms and needs for physical health interventions in outpatients with schizophrenia, and factors predicting those needs. METHODS A structured, comprehensive health examination was carried out, including a visit to a nurse and a general practitioner on 275 outpatients with schizophrenia. The required interventions were classified by type of disease. Logistic regression was used to assess the influence of sociodemographic factors, lifestyle, functional limitations, factors related to psychiatric disorder, and healthcare use on the need for interventions. RESULTS In total, 44.9% of the patients (mean age 44.9 years) reported somatic symptoms affecting daily life; 87.6% needed specific interventions for a disease or condition, most commonly for cardiovascular, dermatological, dental, ophthalmological, and gastrointestinal conditions, and for altered glucose homeostasis. Smoking and obesity predicted significantly a need of any intervention, but the predictors varied in each disease category. Strikingly, use of general practitioner services during the previous year did not reduce the need for interventions. CONCLUSIONS Health examinations for outpatients with schizophrenia revealed numerous physical healthcare needs. The health examinations for patients with schizophrenia should contain a medical history taking and a physical examination, in addition to basic measurements and laboratory tests. Prevention and treatment of obesity and smoking should be given priority in order to diminish somatic comorbidities in schizophrenia.
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Affiliation(s)
- Saana Eskelinen
- a Kellokoski Hospital , Tuusula , Finland.,b Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
| | | | - Kaisla Joutsenniemi
- c Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Matti Holi
- c Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Tuomas H Koskela
- d Department of General Practice , University of Tampere , Tampere , Finland
| | - Jaana Suvisaari
- b Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
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Schmitz A, Rohrich M, Newman W, Wolf P. Cardiometabolic management in severe mental illness requiring an atypical antipsychotic. Ment Health Clin 2017; 7:81-87. [PMID: 29955503 PMCID: PMC6007663 DOI: 10.9740/mhc.2017.03.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Cardiometabolic management was evaluated in patients with diabetes and a severe mental illness that require treatment with an atypical antipsychotic. METHODS Seventy-four patients with diabetes and a severe mental illness treated with an atypical antipsychotic from the Fargo Veterans' Affairs Health Care System were included in this retrospective study. Primary end points analyzed the change in hemoglobin A1c (Hgb A1c), blood pressure, and low-density lipoprotein (LDL) cholesterol 12 months prior to and 12 months following the initiation of an atypical antipsychotic. Secondary end points evaluated changes specific to clozapine and olanzapine. Additional secondary end points evaluated the medication management for cardiometabolic disease prior to and following atypical antipsychotic initiation. RESULTS In the 12 months following atypical antipsychotic initiation, there were no statistically significant changes in metabolic parameters. Mean Hgb A1c increased from 6.9% to 7.2% (P = .47), mean systolic blood pressure decreased slightly from 132 to 127.8 mm Hg (P = .97), mean diastolic blood pressure decreased slightly from 79.6 to 76.6 mm Hg (P = .19), and mean LDL remained unchanged at 104.4 mg/dL (P = .92). Medications to control cardiometabolic disease increased substantially following atypical antipsychotic initiation; 35.1%, 39.2%, and 39.2% of patients were started on one or more new antihyperglycemics, antihypertensives, and statins, respectively. DISCUSSION Patients had a significant increase in prescriptions to manage cardiometabolic disease in the 12 months following initiation of an atypical antipsychotic. Although medications to manage cardiometabolic disease increased, the actual metabolic parameters did not significantly change during the same time period.
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Affiliation(s)
- Allison Schmitz
- Mental Health Clinical Pharmacy Specialist, Fargo VA Health Care System, Fargo, North Dakota,
| | - Melissa Rohrich
- Chief of Pharmacy Services, Fargo VA Health Care System, Fargo, North Dakota
| | - William Newman
- Chief of Endocrinology, Fargo VA Health Care System, Fargo, North Dakota; Professor of Medicine and Acting Chair, Department of Internal Medicine, University of North Dakota School of Medicine & Health Sciences Southeast Campus, Fargo, North Dakota
| | - Pamela Wolf
- Mental Health Clinical Pharmacy Specialist, Fargo VA Health Care System, Fargo, North Dakota
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Prudent C, Evrard R, de Tychey C. La classification de la paranoïa dans la psychiatrie américaine contemporaine : une revue de la littérature. EVOLUTION PSYCHIATRIQUE 2017. [DOI: 10.1016/j.evopsy.2016.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39:2126-2140. [PMID: 27879358 PMCID: PMC5127231 DOI: 10.2337/dc16-2053] [Citation(s) in RCA: 605] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Deborah Young-Hyman
- Office of Behavioral and Social Science Research, National Institutes of Health, Bethesda, MD
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Jeffrey S Gonzalez
- Yeshiva University and the Albert Einstein College of Medicine, Bronx, NY
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Trépanier MO, Hopperton KE, Mizrahi R, Mechawar N, Bazinet RP. Postmortem evidence of cerebral inflammation in schizophrenia: a systematic review. Mol Psychiatry 2016; 21:1009-26. [PMID: 27271499 PMCID: PMC4960446 DOI: 10.1038/mp.2016.90] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 12/13/2022]
Abstract
Schizophrenia is a psychiatric disorder which has a lifetime prevalence of ~1%. Multiple candidate mechanisms have been proposed in the pathogenesis of schizophrenia. One such mechanism is the involvement of neuroinflammation. Clinical studies, including neuroimaging, peripheral biomarkers and randomized control trials, have suggested the presence of neuroinflammation in schizophrenia. Many studies have also measured markers of neuroinflammation in postmortem brain samples from schizophrenia patients. The objective of this study was to conduct a systematic search of the literature on neuroinflammation in postmortem brains of schizophrenia patients indexed in MEDLINE, Embase and PsycINFO. Databases were searched up until 20th March 2016 for articles published on postmortem brains in schizophrenia evaluating microglia, astrocytes, glia, cytokines, the arachidonic cascade, substance P and other markers of neuroinflammation. Two independent reviewers extracted the data. Out of 5385 articles yielded by the search, 119 articles were identified that measured neuroinflammatory markers in schizophrenic postmortem brains. Glial fibrillary acidic protein expression was elevated, lower or unchanged in 6, 6 and 21 studies, respectively, and similar results were obtained for glial cell densities. On the other hand, microglial markers were increased, lower or unchanged in schizophrenia in 11, 3 and 8 studies, respectively. Results were variable across all other markers, but SERPINA3 and IFITM were consistently increased in 4 and 5 studies, respectively. Despite the variability, some studies evaluating neuroinflammation in postmortem brains in schizophrenia suggest an increase in microglial activity and other markers such as SERPINA3 and IFITM. Variability across studies is partially explained by multiple factors including brain region evaluated, source of the brain, diagnosis, age at time of death, age of onset and the presence of suicide victims in the cohort.
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Affiliation(s)
- M O Trépanier
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - K E Hopperton
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Mizrahi
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - N Mechawar
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - R P Bazinet
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
People with schizophrenia have 2- to 5-fold higher risk of type 2 diabetes than the general population. The traditional risk factors for type 2 diabetes, especially obesity, poor diet, and sedentary lifestyle, are common in people with schizophrenia already early in the course of illness. People with schizophrenia also often have low socioeconomic status and income, which affects their possibilities to make healthy lifestyle choices. Antipsychotic medications increase the risk of type 2 diabetes both directly by affecting insulin sensitivity and indirectly by causing weight gain. Lifestyle modification interventions for prevention of diabetes should be an integral part of treatment of patients with schizophrenia. In the treatment of type 2 diabetes in patients with schizophrenia, communication and collaboration between medical care and psychiatric treatment providers are essential.
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Affiliation(s)
- Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
| | - Jaakko Keinänen
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
| | - Saana Eskelinen
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
- Kellokoski Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
- Douglas Mental Health University Institute, Pavillon Newman - 6875, boul. laSalle, Montréal, Québec, Canada, H4H 1R3.
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Simeone JC, Ward AJ, Rotella P, Collins J, Windisch R. An evaluation of variation in published estimates of schizophrenia prevalence from 1990─2013: a systematic literature review. BMC Psychiatry 2015; 15:193. [PMID: 26263900 PMCID: PMC4533792 DOI: 10.1186/s12888-015-0578-7] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/28/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a lack of consistency in findings across studies on the prevalence of schizophrenia, and no recent systematic review of the literature exists. The purpose of this study is to provide an updated systematic review of population-based prevalence estimates and to understand the factors that could account for this variation in prevalence estimates. METHODS MEDLINE, Embase, and PsycInfo databases were searched for observational studies describing schizophrenia prevalence in general populations from 2003-2013 and supplemented by studies from a prior review covering 1990-2002. Studies reporting prevalence estimates from specialized populations such as institutionalized, homeless, or incarcerated persons were excluded. Prevalence estimates were compared both across and within studies by factors that might contribute to variability using descriptive statistics. RESULTS Sixty-five primary studies were included; thirty-one (48 %) were from Europe and 35 (54 %) were conducted in samples of ≥50,000 persons. Among 21 studies reporting 12-month prevalence, the median estimate was 0.33 % with an interquartile range (IQR) of 0.26 %-0.51 %. The median estimate of lifetime prevalence among 29 studies was 0.48 % (IQR: 0.34 %-0.85 %). Prevalence across studies appeared to vary by study design, geographic region, time of assessment, and study quality scores; associations between study sample size and prevalence were not observed. Within studies, age-adjusted estimates were higher than crude estimates by 17 %-138 %, the use of a broader definition of schizophrenia spectrum disorders compared to schizophrenia increased case identification by 18 %-90 %, identification of cases from inpatient-only settings versus any setting decreased prevalence by 60 %, and no consistent trends were noted by differing diagnostic criteria. CONCLUSIONS This review provides updated information on the epidemiology of schizophrenia in general populations, which is vital information for many stakeholders. Study characteristics appear to play an important role in the variation between estimates. Overall, the evidence is still sparse; for many countries no new studies were identified.
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Affiliation(s)
| | | | - Philip Rotella
- Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA.
| | - Jenna Collins
- Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA.
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Partti K, Vasankari T, Kanervisto M, Perälä J, Saarni SI, Jousilahti P, Lönnqvist J, Suvisaari J. Lung function and respiratory diseases in people with psychosis: population-based study. Br J Psychiatry 2015; 207:37-45. [PMID: 25858177 DOI: 10.1192/bjp.bp.113.141937] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 10/17/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is little information on lung function and respiratory diseases in people with psychosis. AIMS To compare the respiratory health of people with psychosis with that of the general population. METHOD In a nationally representative sample of 8028 adult Finns, lung function was measured by spirometry. Information on respiratory diseases and symptoms was collected. Smoking was quantified with serum cotinine levels. Psychotic disorders were diagnosed utilising the Structured Clinical Interview for DSM-IV (SCID-I) and medical records. RESULTS Participants with schizophrenia and other non-affective psychoses had significantly lower lung function values compared with the general population, and the association remained significant for schizophrenia after adjustment for smoking and other potential confounders. Schizophrenia was associated with increased odds of pneumonia (odds ratio (OR) = 4.9), chronic obstructive pulmonary disease (COPD, OR = 4.2) and chronic bronchitis (OR = 3.8); and with high cotinine levels. CONCLUSIONS Schizophrenia is associated with impaired lung function and increased risk for pneumonia, COPD and chronic bronchitis.
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Affiliation(s)
- Krista Partti
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Tuula Vasankari
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Merja Kanervisto
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Jonna Perälä
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Samuli I Saarni
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Pekka Jousilahti
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Jouko Lönnqvist
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Jaana Suvisaari
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
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Ward M, Druss B. The epidemiology of diabetes in psychotic disorders. Lancet Psychiatry 2015; 2:431-451. [PMID: 26360287 DOI: 10.1016/s2215-0366(15)00007-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/09/2015] [Indexed: 01/14/2023]
Abstract
Diabetes is highly prevalent in people with psychotic disorders, including schizophrenia and schizoaffective disorders. Exact prevalence is difficult to estimate, since diabetes is often underdiagnosed in people with psychosis. Results of several studies show that the prevalence of diabetes exceeds that in the general population, with documented prevalence in those with psychosis ranging from 1·26% to 50% across studies (median 13%). The association between diabetes and psychosis is complex and multifactorial. Many of the traditional risk factors for disease have increased prevalence in patients with psychotic disorders. In addition to these traditional risk factors, people with psychosis have unique risks that might have additive or even synergistic effects. These risks include the use of antipsychotic medication, the effects of adverse social determinants of health, and genetic loading. Despite evidence that rates of diabetes are increased in individuals with psychosis, many of these patients are not diagnosed or treated, resulting in increased diabetes-associated morbidity and mortality. Specific patient factors, provider issues, and systems-level factors contribute to the treatment gap. Interventions at both the clinical and public health levels are needed to successfully address this problem.
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Affiliation(s)
- Martha Ward
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Benjamin Druss
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Mizuki Y, Takaki M, Okahisa Y, Sakamoto S, Kodama M, Ujike H, Uchitomi Y. Human Rho guanine nucleotide exchange factor 11 gene is associated with schizophrenia in a Japanese population. Hum Psychopharmacol 2014; 29:552-8. [PMID: 25319871 DOI: 10.1002/hup.2435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 07/04/2014] [Accepted: 08/13/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The human Rho guanine nucleotide exchange factor 11 (ARHGEF11) gene is one of the candidate genes for type 2 diabetes mellitus (T2DM). ARHGEF11 is mapped to chromosome 1q21, which has susceptible risk loci for T2DM and schizophrenia. We hypothesized that ARHGEF11 contributes to the pathogenesis of schizophrenia. METHOD We selected eight single nucleotide polymorphisms of ARHGEF11 that had significant associations with T2DM for a case-control association study of 490 patients with schizophrenia and 500 age-matched and sex-matched controls. RESULTS We did not find any differences in allelic, genotypic associations, or minor allele frequencies with schizophrenia. Analysis of the rs6427340-rs6427339 haplotype and the rs822585-rs6427340-rs6427339 haplotype combination provided significant evidence of an association with schizophrenia (global permutations p = 0.00047 and 0.0032, respectively). C-C of the rs6427340-rs6427339 haplotype and A-C-C of the rs822585-rs6427340-rs6427339 haplotype carried higher risk factors for schizophrenia (permutation p = 0.0010 and 0.0018, respectively). A-C-T of the rs822585-rs6427340-rs6427339 haplotype had a possible protective effect (permutation p = 0.031). CONCLUSION These results provide new evidence that ARHGEF11 may constitute a risk factor for schizophrenia.
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Affiliation(s)
- Yutaka Mizuki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Vancampfort D, Wampers M, Mitchell AJ, Correll CU, De Herdt A, Probst M, De Hert M. A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls. World Psychiatry 2013; 12:240-50. [PMID: 24096790 PMCID: PMC3799255 DOI: 10.1002/wps.20069] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A meta-analysis was conducted to explore the risk for cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia and age- and gender- or cohort-matched general population controls. Our literature search generated 203 relevant studies, of which 136 were included. The final dataset comprised 185,606 unique patients with schizophrenia, and 28 studies provided data for age- and gender-matched or cohort-matched general population controls (n=3,898,739). We found that multi-episode patients with schizophrenia were at increased risk for abdominal obesity (OR=4.43; CI=2.52-7.82; p<0.001), hypertension (OR=1.36; CI=1.21-1.53; p<0.001), low high-density lipoprotein cholesterol (OR=2.35; CI=1.78-3.10; p<0.001), hypertriglyceridemia (OR=2.73; CI=1.95-3.83; p<0.001), metabolic syndrome (OR=2.35; CI=1.68-3.29; p<0.001), and diabetes (OR=1.99; CI=1.55-2.54; p<0.001), compared to controls. Multi-episode patients with schizophrenia were also at increased risk, compared to first-episode (p<0.001) and drug-naïve (p<0.001) patients, for the above abnormalities, with the exception of hypertension and diabetes. Our data provide further evidence supporting WPA recommendations on screening, follow-up, health education and lifestyle changes in people with schizophrenia.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
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Keller WR, Fischer BA, McMahon RP, Meyer W, Buchanan RW. Open-label salsalate for the treatment of pre-diabetes in people with schizophrenia. Schizophr Res 2013; 147:408-9. [PMID: 23680037 DOI: 10.1016/j.schres.2013.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 01/04/2023]
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Abstract
OBJECTIVE We investigated mortality and its determinants in people with psychotic disorder. METHODS A nationally representative two-stage cluster sample of 8028 persons aged 30 years or older from Finland was selected for a comprehensive health survey conducted from 2000 to 2001. Participants were screened for psychotic disorder, and screen-positive persons were invited for a Structured Clinical Interview for DSM-IV. The diagnostic assessment of DSM-IV psychotic disorders was based on the Structured Clinical Interview for DSM-IV, case records from mental health treatments, or both. Mortality was followed up until September 2009 and analyzed using Cox proportional hazards model. RESULTS People with schizophrenia (hazard ratio [HR] = 3.03; 95% confidence interval [CI] = 1.93-4.77) and other nonaffective psychoses (HR = 1.84; 95% CI = 1.17-2.91) had elevated mortality risk, whereas people with affective psychoses did not (HR = 0.61; 95% CI = 0.24-1.55). Antipsychotic medication use was associated with increased mortality (HR = 2.34; 95% CI = 1.86-2.96). There was an interaction between antipsychotic medication use and the presence of a psychotic disorder: antipsychotic medication use was only associated with elevated mortality in persons who were using antipsychotics and did not have primary psychotic disorder. In persons with psychotic disorder, mortality was predicted by smoking and Type 2 diabetes at baseline survey. CONCLUSIONS Schizophrenia and nonaffective psychoses are associated with increased mortality risk, whereas affective psychoses are not. Antipsychotic medication use increases mortality risk in older people without primary psychotic disorder, but not in individuals with schizophrenia. Smoking and Type 2 diabetes are important predictors of elevated mortality risk in persons with psychotic disorder.
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Burghardt KJ, Pop-Busui R, Bly MJ, Grove TB, Taylor SF, Ellingrod VL. The influence of the brain-derived neurotropic factor Val66Met genotype and HMG-CoA reductase inhibitors on insulin resistance in the schizophrenia and bipolar populations. Clin Transl Sci 2012; 5:486-90. [PMID: 23253673 PMCID: PMC4426971 DOI: 10.1111/cts.12001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The brain-derived neurotrophic factor (BDNF) Val66Met variant and HMG-COA reductase inhibitors (statins) have been implicated in insulin resistance with a possible increased risk of diabetes. We sought to determine the effect of the BDNF Met variant and statin medication use on insulin resistance in schizophrenia and bipolar disorder using the homeostasis model assessment of insulin resistance (HOMA-IR). METHODS A cross-sectional design was used and patients with diabetes or on any medications affecting glucose regulation were -excluded. Associations between insulin resistance and genotype were then analyzed by ANOVA and regression analysis. Subjects were grouped by BDNF genotype as well as presence of statin. RESULTS Two hundred fifty-two subjects with a mean age of 44 years were included. The group was 53% male and 41% had a diagnosis of bipolar disorder; 78% and 19% were receiving atypical antipsychotics (AAPs) and statin medications, respectively. Analysis showed schizophrenia subjects with the BDNF met allele as well as schizophrenia subjects with both the BDNF met allele and were receiving a statin had significantly higher HOMA-IR values compared to the other groups (p= 0.046 and p= 0.016, respectively). CONCLUSIONS Our results suggest that in the metabolically high-risk population of schizophrenia the BDNF met allele alone and in combination with statin medications is associated with higher insulin resistance values. This was not seen in the bipolar population. Further validation of these associations remains necessary.
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Affiliation(s)
- K J Burghardt
- Department of Clinical Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, USA
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Takayanagi Y, Cascella NG, Sawa A, Eaton WW. Diabetes is associated with lower global cognitive function in schizophrenia. Schizophr Res 2012; 142:183-7. [PMID: 23031192 PMCID: PMC4004180 DOI: 10.1016/j.schres.2012.08.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 08/27/2012] [Accepted: 08/29/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Co-morbidity of schizophrenia (SZ) and metabolic problems such as diabetes mellitus (DM) has been suggested by many studies. Nonetheless, it is still debated whether DM affects cognitive dysfunction associated with SZ and how much treatment for DM is beneficial for cognitive functions in SZ. We addressed these questions by re-assessing the cognitive dataset from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study. METHODS We identified 1289 SZ patients in which scores for several cognitive domains of verbal memory, vigilance, processing speed, reasoning, and working memory together with the composite score and metabolic characteristics (body mass index, dyslipidemia, hypertension, and DM) were available at baseline of the trial. We performed multiple linear regression analyses to assess the impact of DM on cognitive performance of SZ patients, controlling for a number of other confounding factors including obesity, hypertension, and dyslipidemia. We also conducted analyses of covariance to compare cognitive performance among SZ patients without DM and diabetic SZ sub-groups based on anti-diabetic drugs they were receiving at baseline of the trial. RESULTS Co-morbid DM with SZ predicted worse overall cognitive performance and lower scores for three cognitive domains (vigilance, processing speed, and reasoning), but none of the other metabolic factors (i.e., obesity, hypertension and dyslipidemia) correlated with cognitive function in SZ. Furthermore, SZ patients with untreated DM showed poorer overall cognitive performance and a significantly lower score in the domain of vigilance compared with SZ patients without DM. CONCLUSION Our data suggest that DM negatively affects the overall cognitive function of SZ patients.
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Affiliation(s)
- Yoichiro Takayanagi
- Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
| | - Nicola G. Cascella
- Neuropsychiatry Program, Sheppard Enoch Pratt Hospital, Baltimore,
MD, United Sates,Correspondence: Nicola G. Cascella M.D., Neuropsychiatry
Program, Sheppard Enoch Pratt Hospital, 6501 N. Charles Street, Towson, Maryland
21204, United Sates,
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins
University School of Medicine, Baltimore, MD 21287, United States
| | - William W. Eaton
- Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
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Wegelius A, Tuulio-Henriksson A, Pankakoski M, Haukka J, Lehto U, Paunio T, Lönnqvist J, Suvisaari J. An association between high birth weight and schizophrenia in a Finnish schizophrenia family study sample. Psychiatry Res 2011; 190:181-6. [PMID: 21664700 DOI: 10.1016/j.psychres.2011.05.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 05/23/2011] [Accepted: 05/25/2011] [Indexed: 01/25/2023]
Abstract
Longitudinal cohort studies have implicated an association between both low and high birth weight and schizophrenia. It has been suggested that schizophrenia associated genes could augment an individual's susceptibility to adverse prenatal and perinatal environmental events. We investigated the association between birth weight and schizophrenia in a large Finnish schizophrenia family study sample. We utilized the birth weight data of 1051 offspring from 315 Finnish families with at least one offspring with a diagnosis of schizophrenia. We used a multivariate COX frailty model to analyze the effect of birth weight on the risk of developing schizophrenia within the families. Using information from the Medication Reimbursement Register and patient interviews, we further investigated the association of maternal type 2 diabetes and schizophrenia risk among offspring. High birth weight (>4000g) was associated with a 1.68-fold increase in schizophrenia susceptibility. Maternal diabetes at the time of data collection, a proxy for gestational diabetes, was associated with a 1.66-fold increase in the risk of developing schizophrenia among offspring. Our results corroborate recent findings showing an association between high birth weight and schizophrenia. Our results also point to a potential birth-weight independent association between maternal type 2 diabetes and schizophrenia among offspring.
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Affiliation(s)
- Asko Wegelius
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland.
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Suvisaari J, Loo BM, Saarni SE, Haukka J, Perälä J, Saarni SI, Viertiö S, Partti K, Lönnqvist J, Jula A. Inflammation in psychotic disorders: a population-based study. Psychiatry Res 2011; 189:305-11. [PMID: 21798602 DOI: 10.1016/j.psychres.2011.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/03/2011] [Accepted: 07/04/2011] [Indexed: 12/16/2022]
Abstract
We investigated inflammatory markers in psychotic disorders and their association with metabolic comorbidity, antipsychotic medication, smoking, alcohol use, physical condition, and mood. From the population-based Finnish Health 2000 study, we identified all persons with schizophrenia (n=45), other nonaffective psychosis (ONAP) (n=57), affective psychosis (n=37) and chose controls matched by age, sex, and region of residence. We found that persons with schizophrenia had significantly higher sIL-2Rα, IL-1RA and C-reactive protein (CRP), persons with ONAP significantly higher IL-1RA and CRP and persons with affective psychosis almost significantly higher TNF-α compared to their matched controls. Current antipsychotic use was associated with elevated IL-1RA and CRP. After taking metabolic and lifestyle-related variables that associated with inflammatory markers into account, only antipsychotic medication remained associated with elevated IL-1RA and TNF-α which are markers related to the activation of innate immune system. CRP was influenced by both antipsychotic medication and nonaffective psychosis. sIL-2Rα, a marker of T-cell activation, was associated with depressive symptoms, schizophrenia, and affective psychosis. We conclude that in persons with psychotic disorders, activation of mononuclear phagocyte system was mostly related to metabolic comorbidity and antipsychotic medication use, whereas T-cell activation had a more direct relationship with both psychotic disorders and depressive symptoms.
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Affiliation(s)
- Jaana Suvisaari
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
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Lee SY, Park MH, Patkar AA, Pae CU. A retrospective comparison of BMI changes and the potential risk factors among schizophrenic inpatients treated with aripiprazole, olanzapine, quetiapine or risperidone. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:490-6. [PMID: 21146575 DOI: 10.1016/j.pnpbp.2010.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/03/2010] [Accepted: 12/03/2010] [Indexed: 11/15/2022]
Abstract
The objective of this study was to evaluate weight gain and its potential risk factors among different second generation antipsychotics (SGAs). The study was conducted for Korean inpatients with schizophrenia in a university hospital in Seoul, between Jan 2000 and Dec 2007. Data were collected by reviewing the medical records of the patients, who were prescribed to one of the SGAs among aripiprazole, olanzapine, quetiapine or risperidone. The changes of weight and body mass index (BMI); risk of clinically significant weight gain (>7% gain to initial weight) and their associations with various clinical characteristics of such patients were analyzed. Five hundred and eighty-eight (588) and 294 subjects treated with one of the four SGAs for a duration of 1 month and 2 months were included, respectively. Olanzapine showed significantly greater weight and BMI increase at month 1 (p=0.028 for weight; p=0.019 for BMI) and month 2 (p=0.032 for weight; p=0.029 for BMI) than others. Females showed greater BMI increase change (0.70±0.91 kg/m(2), p=0.008) and were also more likely to experience clinically significant weight gain (odd ratio=1.846, 95% CI=1.098 to 3.105, p=0.021) at month 1. Younger patients (<45 years old) had significantly greater weight and BMI increase at both months 1 and 2. Younger patients also showed greater risk for clinically significant weight gain at month 2 (odd odd ratio=2.567, 95% CI=1.196 to 5.508, p=0.016). Low baseline BMI (<25 kg/m(2)) was associated with greater weight gain at month 1 (1.92±2.29 kg, p<0.001) and month 2 (4.07±3.56 kg, p<0.001) and BMI increase at month 1 and month 2 (p<0.001 for both). Patients with low baseline BMI showed higher risk of clinically significant weight gain at both months 1 and 2 (p<0.001 for both). Olanzapine was shown to have higher metabolic risk than other SGAs in inpatients with schizophrenia. The individual's own clinical characteristics also exerted influence on weight gain effects of SGAs. Younger patients with lower baseline BMI were under greater risk of antipsychotic-induced weight gain. More studies are required to verify the role of gender on weight gain.
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Affiliation(s)
- Seung-Yup Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
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Orešič M, Tang J, Seppänen-Laakso T, Mattila I, Saarni SE, Saarni SI, Lönnqvist J, Sysi-Aho M, Hyötyläinen T, Perälä J, Suvisaari J. Metabolome in schizophrenia and other psychotic disorders: a general population-based study. Genome Med 2011; 3:19. [PMID: 21429189 PMCID: PMC3092104 DOI: 10.1186/gm233] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 02/06/2011] [Accepted: 03/23/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Persons with schizophrenia and other psychotic disorders have a high prevalence of obesity, impaired glucose tolerance, and lipid abnormalities, particularly hypertriglyceridemia and low high-density lipoprotein. More detailed molecular information on the metabolic abnormalities may reveal clues about the pathophysiology of these changes, as well as about disease specificity. METHODS We applied comprehensive metabolomics in serum samples from a general population-based study in Finland. The study included all persons with DSM-IV primary psychotic disorder (schizophrenia, n = 45; other non-affective psychosis (ONAP), n = 57; affective psychosis, n = 37) and controls matched by age, sex, and region of residence. Two analytical platforms for metabolomics were applied to all serum samples: a global lipidomics platform based on ultra-performance liquid chromatography coupled to mass spectrometry, which covers molecular lipids such as phospholipids and neutral lipids; and a platform for small polar metabolites based on two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC × GC-TOFMS). RESULTS Compared with their matched controls, persons with schizophrenia had significantly higher metabolite levels in six lipid clusters containing mainly saturated triglycerides, and in two small-molecule clusters containing, among other metabolites, (1) branched chain amino acids, phenylalanine and tyrosine, and (2) proline, glutamic, lactic and pyruvic acids. Among these, serum glutamic acid was elevated in all psychoses (P = 0.0020) compared to controls, while proline upregulation (P = 0.000023) was specific to schizophrenia. After adjusting for medication and metabolic comorbidity in linear mixed models, schizophrenia remained independently associated with higher levels in seven of these eight clusters (P < 0.05 in each cluster). The metabolic abnormalities were less pronounced in persons with ONAP or affective psychosis. CONCLUSIONS Our findings suggest that specific metabolic abnormalities related to glucoregulatory processes and proline metabolism are specifically associated with schizophrenia and reflect two different disease-related pathways. Metabolomics, which is sensitive to both genetic and environmental variation, may become a powerful tool in psychiatric research to investigate disease susceptibility, clinical course, and treatment response.
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Affiliation(s)
- Matej Orešič
- VTT Technical Research Centre of Finland, Tietotie 2, PO Box 1000, FI-02044 VTT, Espoo, Finland
| | - Jing Tang
- VTT Technical Research Centre of Finland, Tietotie 2, PO Box 1000, FI-02044 VTT, Espoo, Finland
| | | | - Ismo Mattila
- VTT Technical Research Centre of Finland, Tietotie 2, PO Box 1000, FI-02044 VTT, Espoo, Finland
| | - Suoma E Saarni
- National Institute for Health and Welfare, Lintulahdenkuja 4, PO Box 30, FI-00271, Helsinki, Finland
| | - Samuli I Saarni
- National Institute for Health and Welfare, Lintulahdenkuja 4, PO Box 30, FI-00271, Helsinki, Finland
- Department of Psychiatry, Helsinki University Central Hospital, Välskärinkatu 12, PO Box 590, FIN-00029 HUCH, Helsinki, Finland
| | - Jouko Lönnqvist
- National Institute for Health and Welfare, Lintulahdenkuja 4, PO Box 30, FI-00271, Helsinki, Finland
- Department of Psychiatry, Helsinki University Central Hospital, Välskärinkatu 12, PO Box 590, FIN-00029 HUCH, Helsinki, Finland
| | - Marko Sysi-Aho
- VTT Technical Research Centre of Finland, Tietotie 2, PO Box 1000, FI-02044 VTT, Espoo, Finland
| | - Tuulia Hyötyläinen
- VTT Technical Research Centre of Finland, Tietotie 2, PO Box 1000, FI-02044 VTT, Espoo, Finland
| | - Jonna Perälä
- National Institute for Health and Welfare, Lintulahdenkuja 4, PO Box 30, FI-00271, Helsinki, Finland
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Lintulahdenkuja 4, PO Box 30, FI-00271, Helsinki, Finland
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Viertiö S, Tuulio-Henriksson A, Perälä J, Saarni SI, Koskinen S, Sihvonen M, Lönnqvist J, Suvisaari J. Activities of daily living, social functioning and their determinants in persons with psychotic disorder. Eur Psychiatry 2011; 27:409-15. [PMID: 21377336 DOI: 10.1016/j.eurpsy.2010.12.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/13/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The determinants of everyday functioning in persons with psychotic disorder have not been widely studied in community dwelling samples. Our aim was to investigate limitations in everyday functioning among subjects with psychotic disorders in a population-based study. METHOD Everyday functioning was assessed in a nationally representative sample of 7112 persons aged 30+ using interviewer observations and self-reports, while verbal fluency and memory were also measured. Diagnostic assessment of DSM-IV psychotic disorders was based on SCID interview and case-note data. Lifetime-ever diagnoses of psychotic disorder were classified into schizophrenia (n=61), other non-affective psychotic disorders (ONAP) (n=79) and affective psychoses (n=45). RESULT Non-affective psychotic disorder was significantly associated with limitations in everyday functioning, as well as with deficits in verbal fluency and memory. Negative symptoms, depression, age, gender, verbal memory deficits, and reduced visual acuity were predictors of limitations in everyday functioning even after controlling for sociodemographic factors and chronic medical conditions, and difficulties in social functioning were also related to expressive speech problems. CONCLUSION Persons with schizophrenia and ONAP have significantly more problems in everyday functioning than the general population. One significant predictor of problems was reduced visual acuity, which at least in some situations could be easily corrected.
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Affiliation(s)
- S Viertiö
- National Institute for Health and Welfare Department of Mental Health and Substance Abuse Services, PO Box 30, 00271 Helsinki, Finland.
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The prevalence and clinical correlates of metabolic syndrome in patients with schizophrenia: findings from a cohort in Turkey. Eur Arch Psychiatry Clin Neurosci 2011; 261:69-78. [PMID: 20517698 DOI: 10.1007/s00406-010-0118-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
Abstract
Most studies point to an increased prevalence of metabolic syndrome (MS) and an increased risk of coronary heart disease (CHD) in schizophrenia patients with MS. The aims of this study were to compare the prevalence of MS in schizophrenia patients with the general population, to explore the clinical correlates and predictors of MS and to evaluate the risk for CHD within 10 years. Consecutive 319 patients, aged 18-75 years, with a diagnosis of schizophrenia according to the DSM-IV were enrolled. The ATP-III, the ATP-IIIA and the IDF criteria were used to define MS. 10-year risk of CHD events was calculated with the Framingham score. One hundred nine (34.2%) patients met the ATP-III criteria, 118 (37%) the ATP-IIIA and 133 (41.7%) the IDF criteria for MS. Patients with MS were older, had a later onset of illness and an older age at first hospitalization. The prevalence of MS in schizophrenia patients was higher from the general population only within the 20-29 age group. Patients with MS had a higher age and sex-corrected 10-year risk of CHD events. The only predictor of MS was the age of illness onset. In conclusion, countries where the general population prevalence of MS is already too high, schizophrenia patients younger than 30 years of age might be under higher risk of morbidity and mortality related with MS. This study points to the necessity for aggressive interventions to correct MS in schizophrenia as early as possible, within the first 10 years of post detection.
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Ross BM, Shah S, Peet M. Increased breath ethane and pentane concentrations in currently unmedicated patients with schizophrenia. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ojpsych.2011.11001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cholesterol and triglycerides in antipsychotic-naive patients with nonaffective psychosis. Psychiatry Res 2010; 178:559-61. [PMID: 20576293 PMCID: PMC4185193 DOI: 10.1016/j.psychres.2010.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 05/01/2010] [Accepted: 06/01/2010] [Indexed: 01/10/2023]
Abstract
Patients with psychosis have an increased prevalence of hyperlipidemia. We compared fasting concentrations of lipids in newly diagnosed, antipsychotic-naïve patients with nonaffective psychosis (N=87) and control subjects (N=92). After accounting for gender, age, smoking, socioeconomic status, and body mass index, there was no significant difference between the two groups in total cholesterol, high-density lipoproteins, low-density lipoproteins, or triglycerides.
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Okumura Y, Ito H, Kobayashi M, Mayahara K, Matsumoto Y, Hirakawa J. Prevalence of diabetes and antipsychotic prescription patterns in patients with schizophrenia: a nationwide retrospective cohort study. Schizophr Res 2010; 119:145-52. [PMID: 20304611 DOI: 10.1016/j.schres.2010.02.1061] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/22/2010] [Accepted: 02/19/2010] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite an increasing concern that atypical antipsychotics seem to have a stronger diabetogenic risk than conventional antipsychotics, little information is available on the prevalence of diabetes among schizophrenia patients, and prescription patterns for patients with comorbid schizophrenia and diabetes in Japan. OBJECTIVES To compare the prevalence of diabetes between schizophrenia patients and the general population and to investigate whether diabetes status correlates the prescription patterns of antipsychotics at hospital discharge. METHODS Schizophrenia patients who were discharged between April 2004 and March 2005 and who continued to receive outpatient treatment from 526 hospitals were included in this retrospective open cohort study. We collected information about the doctor diagnosis of diabetes during hospitalization, and drug prescriptions for schizophrenia at hospital discharge using medical charts. RESULTS The overall prevalence of diabetes was 8.6% among patients with schizophrenia. Compared with the general population, the estimates of diabetes prevalence in the schizophrenia population were 2.6-10.8 percentage point higher among males aged 30-49 years, and 1.9-9.9 percentage point higher among females aged 40-59 years. The odds of being prescribed conventional antipsychotics were about 2 times higher among patients with diabetes than without diabetes, relative to atypical and combination of conventional and atypical antipsychotics. These results were robust across various sensitivity analyses. CONCLUSION When treating schizophrenia patients with preexisting diabetes, psychiatrists need to monitor the occurrence of diabetes regularly regardless of antipsychotic class, strike a balance, and provide the most efficacious antipsychotic medication.
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Affiliation(s)
- Yasuyuki Okumura
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Weinmann S, Aderhold V. Antipsychotic medication, mortality and neurodegeneration: The need for more selective use and lower doses. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2010. [DOI: 10.1080/17522430903501999] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Coronary heart disease and cardiac conduction abnormalities in persons with psychotic disorders in a general population. Psychiatry Res 2010; 175:126-32. [PMID: 19926142 DOI: 10.1016/j.psychres.2008.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 06/26/2008] [Accepted: 07/31/2008] [Indexed: 11/21/2022]
Abstract
We investigated the prevalence of coronary heart disease (CHD) and myocardial infarction (MI) in persons with DSM-IV psychotic disorders. We also examined cardiac conduction abnormalities, and the role of antipsychotic medication in them. The study was based on a nationally representative survey of 8028 persons aged 30 years or over from Finland. Diagnoses of CHD and MI were based on electrocardiographic findings, health examination, and register information. QTc was calculated using the Bazett formula, and Minnesota classification was used for conduction abnormalities. We found that large Q-waves suggesting past MI were significantly more frequent in persons with schizophrenia, while the prevalence of CHD in persons with psychotic disorders did not differ significantly from the remaining study sample. Prevalence of prolonged QTc interval was significantly increased in persons with schizophrenia and in users of typical antipsychotics. However, low-potency antipsychotic use but not diagnosis of schizophrenia remained an independent predictor of prolonged QTc interval in a logistic regression. Low-potency antipsychotic use was associated with ventricular conduction defects, and high-potency antipsychotic use with premature beats. Symptoms and signs of CHD should be actively monitored patients with schizophrenia, and the electrocardiogram should be monitored for all types of changes in persons receiving antipsychotic medication.
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Saarni SE, Saarni SI, Fogelholm M, Heliövaara M, Perälä J, Suvisaari J, Lönnqvist J. Body composition in psychotic disorders: a general population survey. Psychol Med 2009; 39:801-810. [PMID: 18713488 DOI: 10.1017/s0033291708004194] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The literature suggests an association between obesity and schizophrenia but fat mass and fat-free mass, which have been shown to be more predictive of all-cause mortality than only waist circumference and obesity [body mass index (BMI) 30 kg/m2], have not been reported in psychotic disorders. We examined the detailed body composition of people with different psychotic disorders in a large population-based sample. METHOD We used a nationally representative sample of 8082 adult Finns aged 30 years with measured anthropometrics (height, weight, waist circumference, fat percentage, fat-free mass and segmental muscle mass). Psychiatric diagnoses were based on a consensus procedure utilizing the Structured Clinical Interview for DSM-IV (SCID)-interview, case-notes and comprehensive register data. RESULTS Schizophrenia (including schizo-affective disorder) was associated with obesity [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.5-3.6], abdominal obesity (waist circumference 88 cm for women, 102 cm for men) (OR 2.2, 95% CI 1.3-3.6) and with higher fat percentage (mean difference 3.8%, 95% CI 2.0-5.7%), adjusted for age and gender, than in the remaining sample. The associations between schizophrenia and low fat-free mass and decreased muscle mass on trunk and upper limbs became statistically significant after adjusting for BMI. After further adjusting for current antipsychotic medication, education, diet and smoking, schizophrenia remained associated with obesity (OR 1.9, 95% CI 1.1-3.6) and abdominal obesity (OR 3.8, 95% CI 1.5-9.4). Participants with affective psychoses did not differ from the general population. CONCLUSIONS Individuals with schizophrenia have metabolically unfavorable body composition, comprising abdominal obesity, high fat percentage and low muscle mass. This leads to increased risk of metabolic and cardiovascular diseases.
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Affiliation(s)
- S E Saarni
- National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland.
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Mobility limitations in persons with psychotic disorder: findings from a population-based survey. Soc Psychiatry Psychiatr Epidemiol 2009; 44:325-32. [PMID: 18802653 DOI: 10.1007/s00127-008-0433-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are few reports on mobility limitations in persons with psychotic disorder although restrictions in mobility may aggravate the general functional limitations of these patients. Our aim was to investigate mobility limitations among subjects with psychotic disorder in a general population-based sample. METHODS A nationally representative sample of 6,927 persons aged 30 and older self-reported mobility limitations in an interview and was examined in performance tests. Diagnostic assessment of DSM-IV psychotic disorders combined SCID interview and case note data. Lifetime-ever diagnoses of psychotic disorder were classified into schizophrenia, other nonaffective psychotic disorders and affective psychoses. RESULTS Self-reported mobility limitations were highly prevalent in persons with schizophrenia and other nonaffective psychosis, but not in the affective psychosis group. After adjusting for age and sex, persons with schizophrenia and other nonaffective psychoses but not affective psychoses had significantly increased odds of having both self-reported and test-based mobility limitations as well as weak muscle strength. Schizophrenia remained an independent predictor of mobility limitations even after controlling for lifestyle-related factors and chronic medical conditions. Among persons with nonaffective psychoses, higher levels of negative symptoms predicted mobility limitations. CONCLUSION Self-reported mobility limitations are prevalent already at a young age in persons with schizophrenia and other nonaffective psychotic disorders, and among older persons with these disorders both self-reported limitations and measured performance tests show lower capacity in mobility. Difficulties in mobility are associated with negative symptoms. Mental health care professionals should pay attention to mobility limitations in persons with psychotic disorder.
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Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization. Soc Psychiatry Psychiatr Epidemiol 2009; 44:135-42. [PMID: 18663397 DOI: 10.1007/s00127-008-0414-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Excess mortality among people with schizophrenia due to natural and unnatural causes, especially due to suicides, is a well-known fact. It has been suggested that deinstitutionalization increases suicide mortality but there are also contradictory results. We studied the changes in mortality and causes of death among schizophrenia sufferers during and after the years of deinstitutionalization process in Finland. METHOD The sample, identified from the Finnish hospital discharge register (FHDR), consisted of patients aged 15-65 and hospitalized for the first time due to schizophrenia. We focused on the 5-year follow-up from inclusion years 1980-1998 (N=23,959). Changes in 5-year follow-up mortality during the study period were explored for both genders and for different causes of death separately using multivariate logistic regression analyses. RESULTS During the study period 1,926 deaths occurred. Suicide was the major cause of death in both genders. A significant reduction in overall 5-year mortality was observed among persons hospitalized in 1995-1998 when compared to people hospitalized 1980-1984. In males a significant reduction was seen in all mortality (P=0.025) due to suicides (P=0.007) but not in the case of natural deaths. In females no significant changes in mortality were found. CONCLUSIONS Our study confirms a reduction in suicide mortality of male schizophrenia sufferers after the deinstitutionalization process. However the overall mortality is still very high and the attention needs to be focused on the general well-being of schizophrenia patients.
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Pierce R. What a tangled web we weave: ethical and legal implications of deception in recruitment. Account Res 2008; 15:262-82. [PMID: 18972266 DOI: 10.1080/08989620802388713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Deception in human subject research is neither uncommon nor prohibited. The use of deception in the recruitment phase of clinical research has received relatively little attention. Given that informed consent is foundational to human subject research, the practice of misrepresenting the study purpose in clinical research would seem to contradict one of the fundamental tenets of ethical human subjects research. Using the example of prodromal psychosis, this article the ethical and legal implications of deception in recruitment and the sufficiency of current guidance on the practice when the study involves a stigmatizing condition, the collection of genetic samples, or both. I conclude that when these two elements are present, deception should only be used when absolutely necessary and, if used, researchers should be required to debrief participants before the collection of genetic samples and give particular attention to minimizing risks of privacy breaches.
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Affiliation(s)
- Robin Pierce
- Novel Tech Ethics, Dalhousie University, Halifax, Nova Scotia, Canada.
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