After six months of anti-psychotic treatment: Is the improvement in mental health at the expense of physical health?

Prevalence of metabolic syndrome and related factors in a large sample of antipsychotic naïve patients with first-episode psychosis: Baseline results from the PAFIP cohort

BACKGROUND

Few investigations have been carried out on metabolic syndrome in antipsychotic- naïve patients with schizophrenia.

METHODS

Our primary objective was to compare the prevalence of Metabolic Syndrome (MetS), as defined by the National Cholesterol Education Program, Adult Treatment Panel III in 2001 (NCEP-ATP III), between a Spanish cohort of 303 drug-naïve patients with a first episode of psychosis (FEP) without any previous cardiovascular condition, and 153 healthy individuals.

RESULTS

Participants included 303 patients with FEP (M:F 53:46) and 153 control subjects (M:F 56:43). The mean and standard deviation ages were 31(9.38) and 29 (7.57) years in the study and control groups respectively (F = 4.09; p = 0.93). We found that the prevalence of MetS in drug-naïve patients with FEP (5.6 %) was similar to the prevalence of MetS in age-sex matched controls (5.12 %). However, 60.7 % of patients with FEP met at least one of the five MetS components, while among the control subjects only 36.5 % met at least one component. Additionally, we found that other factors not included among the operational definition of MetS, but still important in cardiovascular risk, were also altered.

CONCLUSION

FEP patients have a greater risk of presenting at least one altered MetS component than healthy controls which could indicate the need of development of screening methods detecting cardiovascular risk. Likewise, gender differences in metabolic components such as waist circumference, which is a predictor of cardiovascular events have been found. Similarly, research should focus on metabolic risk predictors that include not only MetS, but also specific parameters for the early psychosis population.

Metabolic syndrome in antipsychotic-naïve patients with first-episode psychosis: a systematic review and meta-analysis

BACKGROUND

It is unclear what the prevalence of metabolic syndrome (MetS) in drug-naïve first-episode of psychosis (FEP) is, as previous meta-analyses were conducted in minimally exposed or drug-naïve FEP patients with psychotic disorder at any stage of the disease; thus, a meta-analysis examining MetS in naïve FEP compared with the general population is needed.

METHODS

Studies on individuals with FEP defined as drug-naïve (0 days exposure to antipsychotics) were included to conduct a systematic review. A meta-analysis of proportions for the prevalence of MetS in antipsychotic-naïve patients was performed. Prevalence estimates and 95% CI were calculated using a random-effect model. Subgroup analyses and meta-regressions to identify sources and the amount of heterogeneity were also conducted.

RESULTS

The search yielded 4143 articles. After the removal of duplicates, 2473 abstracts and titles were screened. At the full-text stage, 112 were screened, 18 articles were included in a systematic review and 13 articles in the main statistical analysis. The prevalence of MetS in naïve (0 days) FEP is 13.2% (95% CI 8.7-19.0). Ethnicity accounted for 3% of the heterogeneity between studies, and diagnostic criteria used for MetS accounted for 7%. When compared with controls matched by sex and age, the odds ratio is 2.52 (95% CI 1.29-5.07; p = 0.007).

CONCLUSIONS

Our findings of increased rates of MetS in naïve FEP patients suggest that we are underestimating cardiovascular risk in this population, especially in those of non-Caucasian origin. Our findings support that altered metabolic parameters in FEPs are not exclusively due to antipsychotic treatments.

Exploring the Health Status of People with First-Episode Psychosis Enrolled in the Early Intervention in Psychosis Program

People diagnosed with mental disorders are at risk of developing physical health co-morbidities. An exploratory "within-subject" and "between-group" design examined the health outcomes of a group diagnosed with first-episode psychosis enrolled in an early intervention in psychosis program over 12 months. The findings were compared with a group diagnosed with psychosis for more than two years. Participants with first-episode psychosis recorded a significant increase in weight over 12 months when assessed against the comparison group. The findings show that the potential for developing physical health co-morbidities begins from the time of diagnosis and commencement of antipsychotic medications.

Early-Life Adversity, Systemic Inflammation and Comorbid Physical and Psychiatric Illnesses of Adult Life

Recently, the evidence of increased immune activation in patients with schizophrenia has suggested a role for the immune system in the development of psychosis. However, what is causing this increased immune activation and how this leads to the development of psychopathology remain still unclear. In this chapter we discuss the evidence about the role of childhood trauma as possible underlying cause of the increased immune activation in patients with schizophrenia. According to preclinical and clinical models, early adverse events can disrupt the homeostatic control of immune responses and lead to enduring inflammatory dysregulation at a peripheral and central level. In fact, persisting systemic inflammation may facilitate peripheral tissues damage and breach the blood-brain barrier, leading to microglia activation and to neuroinflammation.Such chronic immune dysregulation also appear to partially explain the frequent comorbidity between psychosis and metabolic abnormalities, which have previously mainly considered as side effect of antipsychotic treatment.Overall, this evidence suggests that early stress may contribute to development of schizophrenia spectrum disorders through a modulation of the peripheral and central immune system and support the immune pathways as possible future therapeutic approach for psychosis.

A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls

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.