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Garrido-Torres N, Ruiz-Veguilla M, Alameda L, Canal-Rivero M, Ruiz MJ, Gómez-Revuelta M, Ayesa-Arriola R, Rubio-García A, Crespo-Facorro B, Vázquez-Bourgon J. 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. Schizophr Res 2022; 246:277-285. [PMID: 35878542 DOI: 10.1016/j.schres.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 06/03/2022] [Accepted: 07/10/2022] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Nathalia Garrido-Torres
- Mental Health Unit, Virgen del Rocio University Hospital, Seville, Spain; Translational Psychiatry Group, Seville Biomedical Research Institute (IBiS), Seville, Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Madrid, Spain; Department of Psychiatry, University of Seville, Seville, Spain
| | - Miguel Ruiz-Veguilla
- Mental Health Unit, Virgen del Rocio University Hospital, Seville, Spain; Translational Psychiatry Group, Seville Biomedical Research Institute (IBiS), Seville, Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Madrid, Spain; Department of Psychiatry, University of Seville, Seville, Spain
| | - Luis Alameda
- Mental Health Unit, Virgen del Rocio University Hospital, Seville, Spain; Translational Psychiatry Group, Seville Biomedical Research Institute (IBiS), Seville, Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Madrid, Spain; Department of Psychiatry, University of Seville, Seville, Spain; Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne 1008, Switzerland; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Manuel Canal-Rivero
- Mental Health Unit, Virgen del Rocio University Hospital, Seville, Spain; Translational Psychiatry Group, Seville Biomedical Research Institute (IBiS), Seville, Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Madrid, Spain; Department of Psychiatry, University of Seville, Seville, Spain
| | - María Juncal Ruiz
- Department of Psychiatry, Sierrallana Hospital-Instituto de Investigación Marqués de Valdecilla (IDIVAL), Torrelavega, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Marcos Gómez-Revuelta
- Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Rosa Ayesa-Arriola
- Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Madrid, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Ana Rubio-García
- Mental Health Unit, Virgen del Rocio University Hospital, Seville, Spain; Translational Psychiatry Group, Seville Biomedical Research Institute (IBiS), Seville, Spain
| | - Benedicto Crespo-Facorro
- Mental Health Unit, Virgen del Rocio University Hospital, Seville, Spain; Translational Psychiatry Group, Seville Biomedical Research Institute (IBiS), Seville, Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Madrid, Spain; Department of Psychiatry, University of Seville, Seville, Spain.
| | - Javier Vázquez-Bourgon
- Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Madrid, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Garrido-Torres N, Rocha-Gonzalez I, Alameda L, Rodriguez-Gangoso A, Vilches A, Canal-Rivero M, Crespo-Facorro B, Ruiz-Veguilla M. Metabolic syndrome in antipsychotic-naïve patients with first-episode psychosis: a systematic review and meta-analysis. Psychol Med 2021; 51:2307-2320. [PMID: 34493353 DOI: 10.1017/s0033291721002853] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Nathalia Garrido-Torres
- University Hospital Virgen del Rocio-IBIS, Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain
| | - Idalino Rocha-Gonzalez
- University Hospital Virgen del Rocio-IBIS, Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital (CHUV), CH-1008Lausanne, Switzerland
| | | | - Ana Vilches
- University Hospital Virgen del Rocio, Sevilla, Spain
| | - Manuel Canal-Rivero
- University Hospital Virgen del Rocio-IBIS, Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain
| | - Miguel Ruiz-Veguilla
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain
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Chee GL, Wynaden D, Heslop K. Exploring the Health Status of People with First-Episode Psychosis Enrolled in the Early Intervention in Psychosis Program. Issues Ment Health Nurs 2021; 42:57-64. [PMID: 32787709 DOI: 10.1080/01612840.2020.1797251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Gin-Liang Chee
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia
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Nettis MA, Pariante CM, Mondelli V. Early-Life Adversity, Systemic Inflammation and Comorbid Physical and Psychiatric Illnesses of Adult Life. Curr Top Behav Neurosci 2020; 44:207-225. [PMID: 30895531 DOI: 10.1007/7854_2019_89] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Maria Antonietta Nettis
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Carmine M Pariante
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK.
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
- Maurice Wohl Clinical Neuroscience Institute , London, UK.
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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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