The association between birth weight, ponderal index, psychotropic medication, and type 2 diabetes in individuals with severe mental illness

Anthropometry in antipsychotic-naïve first-episode psychosis patients: An exploratory approach to the role of environmental early life events in two independent samples

BACKGROUND

Patients with schizophrenia exhibit a reduced life expectancy mainly due to medical-related pathologies which might have been initiated due to stressful events during fetal development. Indeed, intra-uterus growth patterns predict anthropometric measures in adulthood, describing risk factors for schizophrenia and metabolic disorders. We aim to evaluate anthropometric values in two cohorts of antipsychotic-naïve first-episode episode psychosis (FEP) and correlated them with surrogate markers of the fetal environment such as birth weight (BW) and season of birth.

METHODS

BW, season of birth, and anthropometric values from 2 cohorts of FEP patients (Barcelona and Santander) were evaluated. In cohort B, 91 patients, and 110 controls while in cohort S, 644 and 235 were included respectively.

RESULTS

Patients were shorter, slimmer, and with lower BMI compared with controls. In both cohorts, patients, and female patients born in winter displayed the shortest height. Regarding BW, height was significantly associated with the interaction of diagnosis and BW in the whole sample and the male subsample.

CONCLUSIONS

Our results confirm reduced anthropometric features in FEP at onset while suggesting the influence of winter birth and BW, highlighting the role of early life events in the later outcome of FEP with sex differences.

Association between phthalate metabolite mixture in neonatal cord serum and birth outcomes

Prenatal exposure to phthalates (PAEs) is ubiquitous among Chinese neonates. PAEs entering the body will be transformed to various hydrolyzed and oxidated PAE metabolites (mPAEs). PAEs and mPAEs exposure may lead to adverse birth outcomes through disruption of multiple hormone signaling pathways, induction of oxidative stress, and alterations in intracellular signaling processes. In this study, the concentrations of 11 mPAEs in 318 umbilical cord serum samples from neonates in Jinan were quantified with HPLC-ESI-MS. Multiple linear regression, Bayesian kernel machine regression, and quantile g-computation models were utilized to investigate the effects of both individual mPAE and mPAE mixture on birth outcomes. Stratified analysis was performed to explore whether these effects were gender-specific. mPAE mixture was negatively associated with birth length (BL) z-score, birth weight (BW) z-score, head circumference (HC) z-score, and ponderal index (PI). Mono(2-ethylhexyl) phthalate (MEHP) manifested negative associations with BL(z-score), BW(z-score), HC(z-score), and PI, whereas mono(2-carboxymethylhexyl) phthalate (MCMHP) was negatively associated with BW(z-score) and PI within the mPAE mixture. Stratified analysis revealed that the negative associations between mPAE mixture and four birth outcomes were attenuated in female infants, while the positive impact of mono(2-ethyl-5carboxypentyl) phthalate (MECPP) on BL(z-score) and BW(z-score) could be detected only in females. In summary, our findings suggest that prenatal exposure to phthalates may be associated with intrauterine growth restriction, and these effects vary according to the gender of the infant.

The effect of early life events on glucose levels in first-episode psychosis

First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients' increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients.

Factors influencing prolactin levels in chronic long-term hospitalized schizophrenic patients with co-morbid type 2 diabetes mellitus

BACKGROUND

For long-term hospitalized patients suffering from schizophrenia, metabolic disease and hyperprolactinemia (HPRL) are common comorbidities. This article is aimed at analyzing the factors influencing comorbid type 2 diabetes mellitus (T2DM) on prolactin (PRL) levels in long-term hospitalized patients suffering from schizophrenia.

METHODS

This study included 378 long-term hospitalized patients with schizophrenia. Common metabolic markers and PRL levels of included samples were collected, and the severity of psychopathology was assessed using the Positive and Negative Symptoms Scale (PANSS). Based on the patients with or without T2DM, the samples were divided into two groups. The differences in clinical parameters between the two groups were compared, and the effects of the parameters on the PRL levels were analyzed.

RESULTS

Compared with non-DM patients, the patients in the DM subgroup had lower PRL levels (P < 0.0001) and rather severe psychiatric symptoms (P = 0.016). Female, treated by risperidone, and high levels of triglyceride (TG) were faced with risk for HPRL (B = 26.31, t = 5.39, P < 0.0001; B = 19.52, t = 4.00, P < 0.0001; B = 2.71, t = 2.31, P = 0.022, respectively). Meanwhile, co-morbid DM and aripiprazole treatment were protective factors (B = 15.47, t = 3.05, P = 0.002; B = -23.77, t = -2.47, P = 0.014; respectively). Ultimately, in the DM subgroup, the dose of metformin was found to be a protective factor for HPRL (B = -0.01, t = -1.46, P = 0.047), while female and aripiprazole were risk factors (B = 16.06, t = 3.26, P = 0.001; B = 20.13, t = 2.57, P = 0.011; respectively).

CONCLUSION

Aripiprazole is a protective factor for HPRL in long-term hospitalized patients, whereas the female is a risk factor. Metformin is beneficial in reducing PRL levels in patients with co-morbid DM. More aggressive and effective interventions are required for preventing adverse drug reactions in women and patients with co-DM.