Detection of metabolic syndrome in schizophrenia and implications for antipsychotic therapy : is there a role for folate?

Gut microbiome and metabolism alterations in schizophrenia with metabolic syndrome severity

BACKGROUND

Schizophrenia (SCZ) patients undergoing antipsychotic treatment demonstrated a high prevalence and harmful effects of metabolic syndrome (MetS), which acted as the major cause of cardiovascular disease. The major clinical challenge is the lack of biomarkers to identify MetS episodes and prevent further damage, while the mechanisms underlying these drug-induced MetS remain unknown.

METHODS

This study divided 173 participants with SCZ into 3 groups (None, High risk, and MetS, consisting of 22, 88, and 63 participants, respectively). The potential biomarkers were searched based on 16S rRNA gene sequence together with metabolism analysis. Logistic regression was used to test the effects of the genus-metabolites panel on early MetS diagnoses.

RESULTS

A genus-metabolites panel, consisting of Senegalimassilia, sphinganine, dihomo-gamma-linolenoylcholine, isodeoxycholic acid, and MG (0:0/22:5/0:0), which involved in sphigolipid metabolism, fatty acid metabolism, secondary bile acid biosynthesis and glycerolipid metabolism, has a great discrimination efficiency to MetS with an area under the curve (AUC) value of 0.911 compared to the None MetS group (P = 1.08E-8). Besides, Senegalimassilia, 3-Hydroxytetradecanoyl carnitine, isodeoxycholic acid, and DG(TXB2/0:0/2:0) distinguished between subgroups robustly and exhibited a potential correlation with the severity of MetS in patients with SCZ, and may act as the biomarkers for early MetS diagnosis.

CONCLUSIONS

Our multi-omics study showed that one bacterial genus-five lipid metabolites panel is the potential risk factor for MetS in SCZ. Furthermore, Senegalimassilia, 3-Hydroxytetradecanoyl carnitine, isodeoxycholic acid, and DG(TXB2/0:0/2:0) could serve as novel diagnostic markers in the early stage. So, it is obvious that the combination of bacterial genus and metabolites yields excellent discriminatory power, and the lipid metabolism provide new understanding to the pathogenesis, prevention, and therapy for MetS in SCZ.

Influence of antipsychotic medications on hyperlipidemia risk in patients with schizophrenia: evidence from a population-based cohort study and in vitro hepatic lipid homeostasis gene expression

Introduction

Schizophrenia increases the risk of mortality and cardiovascular disease (CVD) risk. However, the correlation between antipsychotics (APs) and CVD remains controversial. Hyperlipidemia is a significant risk factor for CVD.

Methods

We conducted a nationwide population-based retrospective cohort study to investigate the effects of APs on the risk of hyperlipidemia and lipid homeostasis gene expression. We used data from the Longitudinal Health Insurance Database of Taiwan on new-onset schizophrenia patients and a comparison cohort without schizophrenia. We used a Cox proportional hazards regression model to analyze the differences in hyperlipidemia development between the two cohorts. Furthermore, we examined the effects of APs on the hepatic expression of lipid homeostasis-related genes.

Results

After adjusting for potential interrelated confounding factors, the case group (N = 4,533) was found to have a higher hyperlipidemia risk than the control cohort (N = 4,533) [adjusted hazard ratio (aHR), 1.30, p < 0.001]. Patients with schizophrenia without APs had a significantly higher risk of hyperlipidemia (aHR, 2.16; p < 0.001). However, patients receiving APs had a significantly lower risk of hyperlipidemia than patients not receiving APs (all aHR ≤ 0.42, p < 0.001). First-generation antipsychotics (FGAs) induce the expression of hepatic lipid catabolism genes in an in vitro model.

Discussion

Patients with schizophrenia had a higher risk of hyperlipidemia than controls; however, compared with non-treated patients, AP users had a lower risk of hyperlipidemia. Early diagnosis and management of hyperlipidemia may help prevent CVD.

The Transtheoretical Model based psychoeducation's effect on healthy lifestyle behaviours in schizophrenia: A randomized controlled trial

OBJECTIVE

The study was conducted with the pretest-posttest randomized controlled trial design to detect the psychoeducation's effect, based on the Transtheoretical Model, on the healthy lifestyle behaviours of individuals with schizophrenia.

METHODS

The data were collected from 82 participants, as 41 intervention and 41 control. The data were collected via personal information form, behavioural change stage diagnosis form and healthy lifestyle scale II. 6-week psychoeducation, consisting of 6 modules, based on the Transtheoretical Model, was applied to the intervention group. No interventions were applied to the control group. Pretests and posttests were applied to both groups.

RESULTS

When the healthy lifestyle scale II of intervention and control groups and final test results arranged according to ANCOVA analysis are compared, average final test results were meaningfully positive for the intervention group with taking control of the pretest and other covariants. When the pretest-posttest results in terms of behavioural change of the intervention group are evaluated; a meaningful difference among nutrition, physical exercises, spiritual self-improvement and stress management, which all are the stages of behavioural change, was detected.

CONCLUSION

It was determined that psychoeducation on a healthy lifestyle, based on the Transtheoretical Model in an individual with schizophrenia affected physical exercises, spiritual self-improvement and interpersonal relationships sub-dimension in medium level, and had a drastic influence on health responsibility, nutrition, stress management sub-dimensions and all healthy lifestyle behaviours. Progress in behavioural change stages was detected.

CLINICAL TRIALS ID

NCT05259748.

Metabolic syndrome in patients with schizophrenia: Why should we care

Metabolic syndrome (MS) is a serious disease in patients with schizophrenia; it is necessary to evaluate the characteristics and influencing factors of MS to provide reliable evidence for the management of schizophrenia. Patients with schizophrenia treated in our hospital from January 1, 2018, to March 31, 2021, were selected. The characteristics and treatment details of MS and no-MS patients were evaluated. Pearson correlation analyses were applied for analyzing MS and related characteristics. Logistic regression analyses were conducted to evaluate the risk factors of MS in patients with schizophrenia. A total of 465 patients with schizophrenia were included, the incidence of MS in patients with schizophrenia was 18.06%. Pearson correlation analyses had found that age (r = 0.621), waist circumference (r = 0.744), body mass index (r = 0.691), diabetes (r = 0.598), course of disease (r = 0.504), triglyceride (r = 0.532), high-density lipoprotein cholesterol (r = -0.518), low-density lipoprotein cholesterol (r = 0.447), and total cholesterol (r = 0.523) were correlated with MS (all P < .05). Logistic regression analyses showed that age ≥55 years (odds ratio [OR]: 2.012, 95% confidence interval [CI]: 1.425-3.196), waist circumference ≥80 cm (OR: 1.944, 95% CI: 1.081-3.172), body mass index ≥24.5 kg/m2 (OR: 2.451, 95% CI: 1.825-3.108), diabetes (OR: 2.301, 95% CI: 1.944-2.881), course of disease ≥15 years (OR: 1.804, 95% CI: 1.236-2.845), triglyceride ≥1.5 mmol/L (OR: 2.032, 95% CI: 1.614-3.079), high-density lipoprotein cholesterol ≤0.8 mmol/L (OR: 1.226, 95% CI: 1.102-1.845), low-density lipoprotein cholesterol ≥2 mmol/L (OR: 1.759, 95% CI: 1.236-1.987), and total cholesterol ≥4.5 mmol/L (OR: 1.664, 95% CI: 1.422-1.852) were the risk factors of MS in patients with schizophrenia (all P < .05). MS is very common in patients with schizophrenia, which may be associated with many possible risk factors, and early interventions and nursing care targeted at those influencing factors are needed to improve the prognosis of schizophrenia.

Metabolic and clinical effect of alpha-lipoic acid administration in schizophrenic subjects stabilized with atypical antipsychotics: A 12-week, open-label, uncontrolled study

Background

Many of the atypical antipsychotics induce metabolic side effects, limiting their use in clinical practice. Alpha-lipoic acid (ALA) was proposed as a new approach in schizophrenia to improve metabolic effects of atypical antipsychotics. The aim of the study is to evaluate the effect of ALA on metabolic and clinical parameters among schizophrenic subjects.

Methods

15 schizophrenic subjects, in stable atypical antipsychotic monotherapy were included in the study. ALA was administrated at the oral daily dose of 600 ​mg/d in addition to antipsychotic therapy. Metabolic, clinical, and psychopathological parameters were measured at typical antipsychotics. e initial screening, and after 12 weeks.

Results

ALA produced a statistically significant reduction in QTc (p ​= ​0.012), blood glucose (p ​= 0.005), AST (p ​= ​0.021), γGT (p ​= ​0.035), CPK (p ​= ​0.005) and prolactinaemia (p ​= ​0.026). In contrast, there was a significant increase in HbA1c (p ​= ​0.026). No effects on body weight and blood lipid levels (triglycerides, total cholesterol, HDL, LDL) emerged.

Conclusions

ALA treatment appeared to be effective for reducing diabetes risk, liver functionality parameters, hyperprolactinaemia and QTC interval. ALA appears to be safe as adjunctive components in schizophrenia.

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Atypical antipsychotics induce the frequent occurrence of metabolic side effects.

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Prevalence rates of Metabolic Syndrome in patients with schizophrenia are high.

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No specific therapies for metabolic effects of SGAs in schizophrenia are still available.

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ALA was suggested as a potential therapeutic agent in various chronic diseases.

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ALA appeared to be effective to improve metabolic values in schizophrenia.

The effect of bezafibrate in preventing glucolipid abnormalities induced by the antipsychotic risperidone

The present study aimed to investigate the effect of bezafibrate on glucolipid abnormalities induced by antipsychotics in schizophrenia. Patients in the treatment group (group A) were treated with antipsychotics and a daily dose of 200 mg bezafibrate for 12 weeks, and patients in the control group (group B) were treated with antipsychotics; sugar, fat and weight changes before and after the treatment were compared between the two groups. Before treatment the differences in TG, TC, LDL-C, HDL-C, body weight and blood glucose between groups A and B were not statistically significant. However, in group B, levels of TG, TC, LDL-C, body weight and blood glucose after treatment showed statistically significant increases, although levels of HDL-C did not register any statistically significant change. By contract, in group A, there were no statistically significant changes in any of the variables measured. Bezafibrate can prevent an increase in sugar, fat and weight gain in treating schizophrenia patients with antipsychotics, and low doses of bezafibrate are safe in the antipsychotic treatment for schizophrenia.

Healthy lifestyle behavior and personal control in people with schizophrenia with healthy controls: A cross-sectional comparative study

The aim of the article was to compare persons with schizophrenia and healthy controls about their life style on their physical health and personal control. Evidences highlights that it helps to change risk behaviours associated with co morbid physical health problems. Subjects were recruited from adult mental health services in tertiary level psychiatric center.Comparisons between the groups were done by using the lifestyle and personal control questionnaire. Subjects were 86 with schizophrenia, 72 were healthy controls. Results showed significant difference. However, physical health was considered to be a less important priority in their personal life by persons with schizophrenia.

Impact of a nurse practitioner role on metabolic monitoring completion and referrals for consumers admitted to the intensive care area of an acute inpatient psychiatric unit

Mental illness increases a person's risk of physical health issues, including cardiovascular disease, leading to premature morbidity and mortality. Screening for cardiovascular disease through metabolic monitoring is recommended to aid in early detection. The aim of the present study was to ascertain whether consumers admitted to an inpatient mental health unit receive routine metabolic monitoring, and to explore the contribution of a nurse practitioner to metabolic monitoring and the actioning of abnormal results. The present study used a retrospective mirror image cohort method to look at clinical consumer files for two separate 6-month periods before and after a nurse practitioner role commenced. Metabolic monitoring variables were computed as completion frequencies and percentages. Univariate analyses were computed to describe differences among metabolic monitoring variables. A total of 497 consumers were admitted to the mental health inpatient unit's intensive care area across the two 6-month data-collection periods. Prior to the nurse practitioner role, only 2% of consumers had their body mass index (BMI) risk calculated; less than 1% had their waist circumference measured, and no abnormal results were referred to a general practitioner (GP). After the nurse practitioner role commenced, BMI risk was calculated for 67% of consumers, waist circumference recorded for 68%, and referrals for abnormal results were forwarded to 37 consumers' GPs. A nurse practitioner on the inpatient mental health unit has allowed for a considerable increase in the metabolic screening of admitted consumers resulting in a number of referrals being forwarded to consumers' GPs to be acted upon.

Antioxidant and anti-inflammatory nutrient status, supplementation, and mechanisms in patients with schizophrenia

Over 50 million people around the world suffer from schizophrenia, a severe mental illness characterized by misinterpretation of reality. Although the exact causes of schizophrenia are still unknown, studies have indicated that inflammation and oxidative stress may play an important role in the etiology of the disease. Pro-inflammatory cytokines are crucial for normal central nervous development and proper functioning of neural networks and neurotransmitters. Patients with schizophrenia tend to have abnormal immune activation resulting in elevated pro-inflammatory cytokine levels, ultimately leading to functional brain impairments. Patients with schizophrenia have also been found to suffer from oxidative stress, a result of an imbalance between the production of free radicals and the ability to detoxify their harmful effects. Furthermore, inflammation and oxidative stress are implicated to be related to the severity of psychotic symptoms. Several nutrients are known to have anti-inflammatory and antioxidant functions through various mechanisms in our body. The present review evaluates studies and literature that address the status and supplementation of omega-3 polyunsaturated fatty acids, vitamin D, B vitamins (B6, folate, B12), vitamin E, and carotenoids in different stages of schizophrenia. The possible anti-inflammatory and antioxidant mechanisms of action of each nutrient are discussed.

Genetic Variation in One-Carbon Metabolism and Changes in Metabolic Parameters in First-Episode Schizophrenia Patients

BACKGROUND

In this study, we aimed to investigate the effects of polymorphisms in genes encoding 1-carbon metabolism enzymes on differential development of metabolic parameters during 12 weeks of treatment with second-generation antipsychotics in first-episode schizophrenia patients.

METHODS

The following polymorphisms in 1-carbon metabolism genes were genotyped: MTHFR (C677T and A1298C), MTHFD1 (G1958A), MTRR (A66G), and BHMT (G742A). A broad panel of metabolic parameters including body mass index, waist circumference, total cholesterol low and high density lipoproteins, triglycerides, homocysteine, folate, and vitamin B12 was determined.

RESULTS

There was a significant effect of the interaction between the MTHFR C677T polymorphism and time on body mass index and waist circumference in the allelic and genotype analyses. Indeed, patients with the MTHFR 677CC genotype had higher increase in body mass index and waist circumference compared with other corresponding genotypes or the MTHFR 677T allele carriers (CT and TT genotypes). In addition, patients with the MTHFR 677TT genotype had higher waist circumference in all time points. Similarly, patients with the MTHFR 677TT genotype had higher body mass index in all time points, but this effect was not significant after correction for multiple testing.

CONCLUSIONS

Our results indicate that the MTHFR C677T polymorphism may predict antipsychotic-induced weight gain. Effects of the MTHFR C677T polymorphism might be different in initial exposure to antipsychotics compared with long-term perspective.

A Systematic Review and Network Meta-Analysis to Assess the Relative Efficacy of Antipsychotics for the Treatment of Positive and Negative Symptoms in Early-Onset Schizophrenia

INTRODUCTION

Early-onset schizophrenia (EOS) is a serious debilitating disorder with considerable morbidity and a reduced life expectancy; therefore, early diagnosis and effective treatments are particularly important. Negative symptoms are more prominent in adolescents and children (compared with adults), and are key predictors of worse functional and clinical outcomes in EOS. Therefore, this study aimed to explore the relative efficacy of antipsychotics used in the treatment of EOS, with a focus on studies reporting effectiveness using the Positive and Negative Syndrome scale (PANSS), a scale that includes an overall symptom measure, in addition to separate subscales for positive and, importantly, negative symptoms.

METHODS

A systematic literature review was conducted using the MEDLINE and Cochrane Central Register of Controlled Trials databases to identify trials conducted in children and adolescents with schizophrenia, and symptom control was reported using the PANSS. A Bayesian random-effects network meta-analysis was performed, synthesising data for a number of outcomes, including mean change from baseline in PANSS scores, treatment discontinuation and weight gain.

RESULTS

Eleven studies were included in the evidence synthesis, comprising 1714 patients across eight active interventions (aripiprazole, haloperidol, molindone, olanzapine, paliperidone, quetiapine, risperidone and ziprasidone) and placebo. All treatments showed a greater reduction in total PANSS scores vs placebo; however, only three interventions (molindone, olanzapine and risperidone) were associated with a statistically significant reduction in total PANSS scores at 6 weeks vs placebo. Haloperidol had the greatest reduction vs placebo; however, this result was not statistically significant [mean difference, -15.6, 95% credible interval (-35.4, 4.1)]. Haloperidol, olanzapine and risperidone showed a statistically significant reduction in positive PANSS scores vs placebo; however, whilst all interventions showed a trend of reduction in negative PANSS scores vs placebo, no comparisons were statistically significant.

CONCLUSIONS

Many of the treatments are efficacious in controlling symptoms, and all showed a trend of superiority vs placebo for total, positive and negative PANSS scores, although only olanzapine and risperidone yielded statistically significant results vs placebo for both total and positive PANSS scores. Varying results for discontinuation and weight gain demonstrate a need to balance efficacy with side-effect profiles.

DNA methylation, insulin resistance and second-generation antipsychotics in bipolar disorder

AIMS

This study aimed to assess the effect of second-generation antipsychotic (SGA) use and insulin resistance on a global measure of DNA methylation in patients diagnosed with bipolar disorder.

MATERIALS & METHODS

Subjects stable on medication (either mood stabilizer monotherapy or adjuvant SGAs) were assessed for insulin resistance. Global methylation levels were assessed in leukocyte DNA from whole blood using the Luminometric Methylation Assay. Multivariable linear regression was used to investigate the effect of insulin resistance and SGA use on DNA methylation.

RESULTS

A total of 115 bipolar I subjects were included in this study. The average age was 43.1 ±12.2 years and 73% were on SGAs. Average% global methylation was 77.0 ± 3.26 and was significantly influenced by insulin resistance, SGA use and smoking.

CONCLUSION

This is the first study to show a relationship between SGA use, insulin resistance and global DNA methylation. Further work will be needed to identify tissue- and gene-specific methylation changes.

Mitochondria and chloroplasts shared in animal and plant tissues: significance of communication

Mitochondria have long been recognized as the main source of energy production for the eukaryotic cell. Recent studies have found that the mitochondria have a variety of dynamic functions aside from the production of energy. It communicates bidirectionally with other organelles in order to modulate its energy balance efficiently, as well as maintain homeostasis, ultimately prolonging its own and the cell’s longevity. The mitochondria achieves this level of regulation via specific and common bidirectional chemical messengers, especially involving the endoplasmic/sarcoplasmic reticulum (ER/SR), deoxyribonucleoside triphosphates (dNTP’s), ATP and the generation of reactive oxygen species (ROS). Its communication network is also involved in stress associated events. In this regard, the activation of the Bax family proteins and the release of cytochrome c occurs during cellular stress. The communication can also promote apoptosis of the cell. When mitochondrial abnormalities cannot be dealt with, there is an increased chance that major illnesses like type 2 diabetes, Alzheimer’s disease, and cancer may occur. Importantly, functioning chloroplasts can be found in animals, suggesting conserved chemical messengers during its evolutionary path. The dynamic capacity of mitochondria is also noted by their ability to function anaerobically. Indeed, this latter phenomenon may represent a return to an earlier developmental stage of mitochondria, suggesting certain disorders result from its untimely appearance.

Endothelial function, folate pharmacogenomics, and neurocognition in psychotic disorders

Cardiovascular disease (CVD) is a well-described complication of schizophrenia, however, mechanisms connecting CVD with other facets of psychotic disorders, such as neurocognition, are not understood. The current study examined folate metabolism as a potential mechanism of CVD and neurocognitive deficits by: 1) using endothelial dysfunction as a biomarker of CVD, and 2) comparing enzymes associated with neurocognition, CVD, and critical to folate metabolism, methylenetetrahydrofolate reductase (MTHFR) and catechol-o-methyl transferase (COMT). Endothelial function was assessed in 147 participants with schizophrenia, schizoaffective disorder, and psychotic disorder not otherwise specified grouped by MTHFR and COMT allele status. Regression models were used to compare neurocognitive performance based on the Brief Assessment of Cognition in Schizophrenia (BACS). Overall, endothelial function predicted BACS composite z-scores after controlling for age, race, level of education, serum folate levels, and MTHFR/COMT risk allele status. Participants with at least one or more MTHFR and/or COMT risk alleles had lower BACS Composite and BACS Symbol Coding adjusted mean z-scores than those with both MTHFR CC and COMT Met/Met genotypes. Thus, endothelial dysfunction may contribute to the neurocognitive deficits seen in psychotic disorders. CVD interventions may not only reduce CVD-related morbidity, but also lessen progressive neurocognitive deficits reported in psychotic disorders.

Homocysteine, cortisol, diabetes mellitus, and psychopathology

OBJECTIVE

This study investigates the association of homocysteine and cortisol with psychological factors in type 2 diabetic patients.

METHOD

Homocysteine, cortisol, and psychological variables were analyzed from 131 diabetic patients. Psychological factors were assessed with the Eysenck Personality Questionnaire (EPQ), Hostility and Direction of Hostility Questionnaire (HDHQ), the Symptom Checklist 90-R (SCL 90-R), the Zung Self-Rating Depression Scale (ZDRS), and the Maudsley O-C Inventory Questionnaire (MOCI). Blood samples were taken by measuring homocysteine and cortisol in both subgroups during the initial phase of the study (T0). One year later (T1), the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments and with an identical blood analysis.

RESULTS

The relation of psychoticism and homocysteine is positive among controlled diabetic patients (P value = 0.006 < 0.05) and negative among uncontrolled ones (P value = 0.137). Higher values of cortisol correspond to lower scores on extraversion subscale (r(p) = -0.223, P value = 0.010). Controlled diabetic patients showed a statistically significant negative relationship between homocysteine and the act-out hostility subscale (r(sp) = -0.247, P = 0.023). There is a statistically significant relationship between homocysteine and somatization (r(sp) = -0.220, P = 0.043).

CONCLUSIONS

These findings support the notion that homocysteine and cortisol are related to trait and state psychological factors in patients with diabetes mellitus type 2.

Antipsychotic induced weight gain: genetics, epigenetics, and biomarkers reviewed

Antipsychotic-induced weight gain (AIWG) is a prevalent side effect of antipsychotic treatment, particularly with second generation antipsychotics, such as clozapine and olanzapine. At this point, there is virtually nothing that can be done to predict who will be affected by AIWG. However, hope for the future of prediction lies with genetic risk factors. Many genes have been studied for their association with AIWG with a variety of promising findings. This review will focus on genetic findings in the last year and will discuss the first epigenetic and biomarker findings as well. Although there are significant findings in many other genes, the most consistently replicated findings are in the melanocortin 4 receptor (MC4R), the serotonin 2C receptor (HTR2C), the leptin, the neuropeptide Y (NPY) and the cannabinoid receptor 1 (CNR1) genes. The study of genetic risk variants poses great promise in creating predictive tools for side effects such as AIWG.

The effectiveness of specialist roles in mental health metabolic monitoring: a retrospective cross-sectional comparison study

BACKGROUND

People with serious mental illness (SMI) exhibit a high prevalence of cardiovascular diseases. Mental health services have a responsibility to address poor physical health in their consumers. One way of doing this is to conduct metabolic monitoring (MM) of risk factors for cardiovascular diseases. This study compares two models of MM among consumers with SMI and describes referral pathways for those at high risk of cardiovascular diseases.

METHODS

A retrospective cross-sectional comparison design was used. The two models were: (1) MM integrated with case managers, and (2) MM integrated with case managers and specialist roles. Retrospective data were collected for all new episodes at two community mental health services (CMHS) over a 12-month period (September 2012 - August 2013).

RESULTS

A total of 432 consumers with SMI across the two community mental health services were included in the analysis. At the service with the specialist roles, MM was undertaken for 78% of all new episode consumers, compared with 3% at the mental health service with case managers undertaking the role. Incomplete MM was systemic to both CMHS, although all consumers identified with high risk of cardiovascular diseases were referred to a general practitioner or other community based health services. The specialist roles enabled more varied referral options.

CONCLUSIONS

The results of this study support incorporating specialist roles over case manager only roles for more effective MM among new episode consumers with SMI.

Methylenetetrahydrofolate reductase gene variants and antipsychotic-induced weight gain and metabolic disturbances

Weight gain and metabolic disturbances represent serious side-effects in antipsychotic (AP) treatment, particularly with clozapine and olanzapine. The methylenetetrahydrofolate reductase (MTHFR) gene is a key determinant in the folate metabolism and previous studies reported a significant effect on AP-induced weight gain and related metabolic abnormalities. Thus, we investigated MTHFR gene variants and changes in several important metabolic parameters in AP-treated patients. In this study, two functional MTHFR polymorphisms, rs1801133 (C677T) and rs1801131 (A1298C), were investigated for changes in weight and metabolic parameters. Genotypic associations were evaluated in a large population (n = 347 including 66 first episode psychosis, FEP patients) treated mostly with clozapine and olanzapine. We did not detect any genotypic association with weight changes (p > 0.05) in our total sample and in the sample refined for ancestry and medication. In our allelic analyses, we observed a trend for the 677-C allele to be associated with weight gain in the total sample (p = 0.03). This effect appeared to be driven by the FEP patients where those carrying the C-allele gained, on average, twice as much weight. Exploratory analyses revealed a significant association between the C677T and the A1298C polymorphism with HDL cholesterol serum levels in patients (p = 0.031). Overall we did not detect a major effect of two functional MTHFR gene variants and AP-induced weight gain. However, our findings suggest an effect of the C677T polymorphism in FEP patients and changes in weight and cholesterol levels. Further investigations in a larger sample are required.

Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes, and interventions

BACKGROUND

Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed.

METHODS

Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors' experience from clinical work and research in the field.

RESULTS

In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population.

DISCUSSION

The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.