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Azimi Manavi B, Corney KB, Mohebbi M, Quirk SE, Stuart AL, Pasco JA, Hodge JM, Berk M, Williams LJ. The neglected association between schizophrenia and bone fragility: a systematic review and meta-analyses. Transl Psychiatry 2024; 14:225. [PMID: 38816361 PMCID: PMC11139985 DOI: 10.1038/s41398-024-02884-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 06/01/2024] Open
Abstract
Schizophrenia is associated with increased risk of medical comorbidity, possibly including osteoporosis, which is a public health concern due to its significant social and health consequences. In this systematic review and meta-analysis, we aimed to determine whether schizophrenia is associated with bone fragility. The protocol for this review has been registered with PROSPERO (CRD42020171959). The research question and inclusion/exclusion criteria were developed and presented according to the PECO (Population, Exposure, Comparison, Outcome) framework. Schizophrenia was identified from medical records, DSM-IV/5 or the ICD. The outcomes for this review were bone fragility [i.e., bone mineral density (BMD), fracture, bone turnover markers, bone quality]. A search strategy was developed and implemented for the electronic databases. A narrative synthesis was undertaken for all included studies; the results from eligible studies reporting on BMD and fracture were pooled using a random effects model to complete a meta-analysis. The conduct of the review and reporting of results adhered to PRISMA guidelines. Our search yielded 3103 studies, of which 29 met the predetermined eligibility criteria. Thirty-seven reports from 29 studies constituted 17 studies investigating BMD, eight investigating fracture, three investigating bone quality and nine investigating bone turnover markers. The meta-analyses revealed that people with schizophrenia had lower BMD at the lumbar spine [standardised mean difference (SMD) -0.74, 95% CI -1.27, -0.20; Z = -2.71, p = 0.01] and at the femoral neck (SMD -0.78, 95% CI -1.03, -0.53; Z = -6.18, p ≤ 0.001). Also observed was a higher risk of fracture (OR 1.43, 95% CI 1.27, 1.61; Z = 5.88, p ≤ 0.001). Following adjustment for publication bias, the association between schizophrenia and femoral neck BMD (SMD -0.63, 95% CI -0.97, -0.29) and fracture (OR 1.32, 95% CI 1.28, 1.35) remained. Significantly increased risk of bone fragility was observed in people with schizophrenia. This association was independent of sex, participant number, methodological quality and year of publication.
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Affiliation(s)
- Behnaz Azimi Manavi
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia.
| | - Kayla B Corney
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
| | - Mohammadreza Mohebbi
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
- Deakin University, Faculty of Health, Biostatistics unit, Geelong, Australia
| | - Shae E Quirk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern, Kuopio, Finland
| | - Amanda L Stuart
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
| | - Julie A Pasco
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jason M Hodge
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, VIC, Australia
| | - Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation-IMPACT, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Azimi Manavi B, Mohebbi M, Stuart AL, Pasco JA, Hodge JM, Weerasinghe DK, Samarasinghe RM, Williams LJ. Antipsychotic medication use in association with quantitative heel ultrasound (QUS). Bone Rep 2023; 18:101694. [PMID: 37333887 PMCID: PMC10276211 DOI: 10.1016/j.bonr.2023.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose Antipsychotic medication use has been associated with decreased bone mineral density; however, less is known whether antipsychotics affect other parameters of bone health. Therefore, the aim of this study was to investigate the association between antipsychotic medication use and quantitative heel ultrasound (QUS) in a population based sample of men and women. Methods Thirty-one antipsychotic users and 155 non-users matched for age and sex were drawn from the Geelong Osteoporosis Study. QUS was undertaken and included the parameters: Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI). Current medication use, lifestyle factors, anthropometry and socio-economic status were collected. Generalized Estimation Equation models were conducted to determine associations between antipsychotic medication use and each of the QUS parameters, adjusting for covariates. Results Antipsychotic users were less active, consumed less alcohol, were more likely to smoke and take antidepressants; otherwise, the groups were similar. After adjusting for age, sex and weight, antipsychotic users had a 7.7 % lower mean BUA [108.70 (95 % CI 104.26-113.14) vs. 116.42 (95 % CI 115.48-117.37) dB/MHz, p = 0.005] and 7.4 % lower mean SI [89.92 (95 % CI 86.89-92.95) vs. 97.30 (95 % CI 96.48-98.12) %, p < 0.001] compared to non-users. Differences in mean SOS between antipsychotic users and non-users failed to reach statistical significance (p = 0.07). Conclusion Antipsychotic use was associated with lower QUS parameters. The risk of bone deterioration should be considered when antipsychotics are prescribed.
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Affiliation(s)
- Behnaz Azimi Manavi
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Amanda L. Stuart
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Julie A. Pasco
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
- Barwon Health, Geelong 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans 3021, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Jason M. Hodge
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
- Barwon Health, Geelong 3220, Australia
| | - D. Kavindi Weerasinghe
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Rasika M. Samarasinghe
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Lana J. Williams
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
- Barwon Health, Geelong 3220, Australia
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Azimi Manavi B, Stuart AL, Pasco JA, Hodge JM, Corney K, Berk M, Williams LJ. Study protocol for the systematic review and meta-analyses of the association between schizophrenia and bone fragility. BMJ Open 2020; 10:e041859. [PMID: 33310808 PMCID: PMC7735127 DOI: 10.1136/bmjopen-2020-041859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Individuals with schizophrenia are known to be at higher risk of comorbid conditions, both physical and psychological. Osteoporosis is possibly one of these, leading to public health concerns due to higher rates of associated mortality and morbidity. We aim to systematically search all available evidence across electronic databases regarding the relationship between schizophrenia and bone fragility. METHODS AND ANALYSIS A systematic search of the research databases CINAHL, MEDLINE Complete, Embase and PsycINFO will be conducted and identified papers reviewed for eligibility, with a second reviewer confirming inclusions. Searches will be run from database inception to 1 October 2020 and supplemented by the hand checking of references of identified articles. A previously published scoring system will be used for assessing the methodological quality and risk of bias. A meta-analysis is planned. ETHICS AND DISSEMINATION Due to including published literature only, ethical permission will not be necessary. Results of this study will be published in a relevant scientific journal and presented at a conference in the field of interest. PROSPERO REGISTRATION NUMBER CRD42020171959.
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Affiliation(s)
- Behnaz Azimi Manavi
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Amanda L Stuart
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Clinical and Biomedical Sciences: Barwon Health, University of Melbourne School of BioSciences, Melbourne, Victoria, Australia
| | - Jason M Hodge
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Geelong Centre for Emerging Infectious Diseases (GCEID), Barwon Health, Geelong, Victoria, Australia
| | - Kayla Corney
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, RoyalMelbourne Hospital, Parkville, Victoria, Australia
- Centre of Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Lana J Williams
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
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van der Leeuw C, de Witte LD, Stellinga A, van der Ley C, Bruggeman R, Kahn RS, van Os J, Marcelis M. Vitamin D concentration and psychotic disorder: associations with disease status, clinical variables and urbanicity. Psychol Med 2020; 50:1680-1686. [PMID: 31327333 DOI: 10.1017/s0033291719001739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The association between schizophrenia and decreased vitamin D levels is well documented. Low maternal and postnatal vitamin D levels suggest a possible etiological mechanism. Alternatively, vitamin D deficiency in patients with schizophrenia is presumably (also) the result of disease-related factors or demographic risk factors such as urbanicity. METHODS In a study population of 347 patients with psychotic disorder and 282 controls, group differences in vitamin D concentration were examined. Within the patient group, associations between vitamin D, symptom levels and clinical variables were analyzed. Group × urbanicity interactions in the model of vitamin D concentration were examined. Both current urbanicity and urbanicity at birth were assessed. RESULTS Vitamin D concentrations were significantly lower in patients (B = -8.05; 95% confidence interval (CI) -13.68 to -2.42; p = 0.005). In patients, higher vitamin D concentration was associated with lower positive (B = -0.02; 95% CI -0.04 to 0.00; p = 0.049) and negative symptom levels (B = -0.03; 95% CI -0.05 to -0.01; p = 0.008). Group differences were moderated by urbanicity at birth (χ2 = 6.76 and p = 0.001), but not by current urbanicity (χ2 = 1.50 and p = 0.224). Urbanicity at birth was negatively associated with vitamin D concentration in patients (B = -5.11; 95% CI -9.41 to -0.81; p = 0.020), but not in controls (B = 0.72; 95% CI -4.02 to 5.46; p = 0.765). CONCLUSIONS Lower vitamin D levels in patients with psychotic disorder may in part reflect the effect of psychosis risk mediated by early environmental adversity. The data also suggest that lower vitamin D and psychopathology may be related through direct or indirect mechanisms.
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Affiliation(s)
- C van der Leeuw
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Mondriaan, Maastricht, the Netherlands
| | - L D de Witte
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A Stellinga
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C van der Ley
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R Bruggeman
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R S Kahn
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J van Os
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - M Marcelis
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands
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Zhu JL, Luo WW, Cheng X, Li Y, Zhang QZ, Peng WX. Vitamin D deficiency and Schizophrenia in Adults: A Systematic Review and Meta-analysis of Observational Studies. Psychiatry Res 2020; 288:112959. [PMID: 32335466 DOI: 10.1016/j.psychres.2020.112959] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
Schizophrenia is a heterogeneous disorder in which there is an interaction between genetic and environmental factors. Accumulating data show that there may be an association between vitamin D deficiency and schizophrenia. We conducted an updated meta-analysis to investigate the relationship between schizophrenia and blood vitamin D level. All published observational articles have been searched from five databases until September 2019. In total, 36 articles with a total of 12528 participants were included in this study. Patients with schizophrenia have significantly lower levels of vitamin D than controls. The subgroup analyses based on study design, hospitalization status, quality score, type of biomarker [25-hydroxyvitamin D or 25-hydroxyvitamin D3], and the country did not explain between-study heterogeneity; however, meta-regression on match factors indicted that match of BMI could account for some degree of heterogeneity. No significant differences in publication bias were observed. Also, subjects with schizophrenia were more likely to have vitamin D deficiency or insufficiency compared to controls. In conclusion, our analyses are consistent with the hypothesis that vitamin D deficiency is associated with schizophrenia. More well-designed randomized control trials are needed to determine whether this association is causal.
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Affiliation(s)
- Jia-Lian Zhu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Wen-Wen Luo
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xuan Cheng
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yun Li
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Qi-Zhi Zhang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Wen-Xing Peng
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China.
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The risk of bone fracture after long-term risperidone exposure is not increased compared to other atypical antipsychotics: A retrospective cohort study. PLoS One 2019; 14:e0221948. [PMID: 31487309 PMCID: PMC6728018 DOI: 10.1371/journal.pone.0221948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Antipsychotic agents can increase circulating serum prolactin levels, potentially leading to osteoporosis and increased risk of bone fracture. The risk appears to be lower for atypical antipsychotics. We investigated whether risperidone was associated with an increased fracture risk by estimating the incidence of hip/femur and non-hip/femur fractures in users of risperidone, other atypical, and typical antipsychotics. METHODS This retrospective cohort study with a nested case-control study used claims data from the Taiwan National Healthcare Insurance database. All new users of antipsychotics between 2000-2012 were included. Incident fractures were identified using ICD-9 codes from inpatient records. Cox proportional hazards models compared fracture incidence among exposure groups. Conditional logistic regression models compared antipsychotic exposure among fracture cases versus matched controls. RESULTS 340,948 patients were included in the analysis. There were 2832 hip/femur fractures and 2693 non-hip/femur fractures: Hip/femur fracture incidence 636.8/100,000 person-years (Risperidone), 885.7/100,000 person-years (Other Atypical), 519.4/100,000 person-years (Typical). The adjusted hazard ratio of hip/femur fracture was 0.92 (95%CI 0.84-1.01) comparing Other Atypical with Risperidone, and 1.00 (95%CI 0.89-1.11) comparing Typical with Risperidone. The adjusted hazard ratio of non-hip/femur fracture was 1.08 (95%CI 0.98-1.20) for Other Atypical versus Risperidone, and 1.10 (95%CI 0.99-1.22) for Typical versus Risperidone. The adjusted odds ratio for hip/femur fractures was 0.92 (95% CI 0.83-1.01) in cases and controls exposed to other atypical antipsychotics compared with risperidone for 1 year prior to fracture date, 0.97 (95% CI 0.87-1.07) during 1-3 years, and 0.92 (95% CI 0.81-1.06) during 3-5 years prior to fracture date. The adjusted odds ratio for non-hip/femur fractures were 1.11 (95% CI 0.99-1.24), 1.02 (95% CI 0.0.91-1.14), and 0.95 (95% CI 0.82-1.09), respectively. CONCLUSION There was no increased risk of bone fracture in long-term users of risperidone compared to users of other atypical antipsychotics.
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Lerner PP, Sharony L, Miodownik C. Association between mental disorders, cognitive disturbances and vitamin D serum level: Current state. Clin Nutr ESPEN 2018; 23:89-102. [DOI: 10.1016/j.clnesp.2017.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 07/31/2017] [Accepted: 11/29/2017] [Indexed: 01/02/2023]
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Adamson J, Lally J, Gaughran F, Krivoy A, Allen L, Stubbs B. Correlates of vitamin D in psychotic disorders: A comprehensive systematic review. Psychiatry Res 2017; 249:78-85. [PMID: 28081455 DOI: 10.1016/j.psychres.2016.12.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/16/2016] [Accepted: 12/30/2016] [Indexed: 12/30/2022]
Abstract
People with psychosis have high prevalence of low vitamin D levels but the correlates and relevance of this deficiency are unclear. A systematic search of major databases from inception to 03/2016 was undertaken investigating correlates of vitamin D in people with psychosis. Data was summarised with a best evidence synthesis. Across 23 included studies (n=1770 psychosis, n=8171 controls) a mean difference in vitamin D levels between both groups of -11.14ng/ml±0.59 was found. 53 unique correlations between vitamin D and outcomes in people with psychosis were identified. The evidence base was broadly equivocal although season of blood sampling (67% of studies found a positive correlation with warmer seasons) and parathyroid hormone (100% of studies found a negative correlation) were associated with vitamin D levels. The most commonly non-correlated variables were: BMI (83% found no correlation), age (73%), gender (86%), smoking (100%), duration of illness (100%) and general assessment of functioning score (100%). In conclusion, whilst many unique correlates have been investigated, there is weak and inconclusive evidence regarding the consistency and meaning of the correlates of vitamin D levels in people with psychosis. Future longitudinal studies should consider the correlates of vitamin D in people with psychosis.
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Affiliation(s)
- James Adamson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
| | - John Lally
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Amir Krivoy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Lauren Allen
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
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El Sayed El Taweel M, El Shafei T. Relationship between vitamin D status and psychopathology in patients with first-episode schizophrenia. MIDDLE EAST CURRENT PSYCHIATRY 2017. [DOI: 10.1097/01.xme.0000508433.27202.4e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chen CY, Lane HY, Lin CH. Effects of Antipsychotics on Bone Mineral Density in Patients with Schizophrenia: Gender Differences. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:238-49. [PMID: 27489377 PMCID: PMC4977815 DOI: 10.9758/cpn.2016.14.3.238] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/06/2016] [Accepted: 02/11/2016] [Indexed: 12/19/2022]
Abstract
Low bone mineral density (BMD) and osteoporosis are common in patients with schizophrenia and detrimental to illness prognosis and life quality. Although the pathogenesis is not fully clear, series of studies have revealed factors related to low BMD such as life style, psychotic symptoms, medication use and the activity of bone absorption markers. It has been known that antipsychotic-induced hyperprolactinemia plays a critical role on decreased BMD. However, it remains uncertain whether the risk factors differ between men and women. According to the effect on prolactin, antipsychotics can be classified into two groups: prolactin-sparing (PS) and prolactin-raising (PR). Our previous study has demonstrated that clozapine which is among the PS antipsychotics is beneficial for BMD when compared with PR antipsychotics in women with chronic schizophrenia. We have also found that risks factors associated with low BMD are different between men and women, suggesting that gender-specific risk factors should be considered for intervention of bone loss in patients with schizophrenia. This article reviews the effects of antipsychotics use on BMD with particular discussion for the differences on gender and age, which implicate the alterations of sex and other related hormones. In addition, currently reported protective and risk factors, as well as the effects of medication use on BMD including the combination of antipsychotics and other psychotropic agents and other potential medications are also reviewed.
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Affiliation(s)
- Chien-Yu Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rpsmen.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Schiavone S, Morgese MG, Mhillaj E, Bove M, De Giorgi A, Cantatore FP, Camerino C, Tucci P, Maffulli N, Cuomo V, Trabace L. Chronic Psychosocial Stress Impairs Bone Homeostasis: A Study in the Social Isolation Reared Rat. Front Pharmacol 2016; 7:152. [PMID: 27375486 PMCID: PMC4896906 DOI: 10.3389/fphar.2016.00152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/26/2016] [Indexed: 12/31/2022] Open
Abstract
Chronic psychosocial stress is a key player in the onset and aggravation of mental diseases, including psychosis. Although a strong association between this psychiatric condition and other medical co-morbidities has been recently demonstrated, few data on the link between psychosis and bone homeostasis are actually available. The aim of this study was to investigate whether chronic psychosocial stress induced by 4 or 7 weeks of social isolation in drug-naïve male Wistar rats could alter bone homeostasis in terms of bone thickness, mineral density and content, as well as markers of bone formation and resorption (sclerostin, cathepsin K, and CTX-I). We found that bone mineral density was increased in rats exposed to 7 weeks of social isolation, while no differences were detected in bone mineral content and area. Moreover, 7 weeks of social isolation lead to increase of femur thickness with respect to controls, suggesting the development of a hyperostosis condition. Isolated rats showed no changes in sclerostin levels, a marker of bone formation, compared to grouped animals. Conversely, bone resorption markers were significantly altered after 7 weeks of social isolation in terms of decrease in cathepsin K and increase of CTX-I. No alterations were found after 4 weeks of isolation rearing. Our observations suggest that chronic psychosocial stress might affect bone homeostasis, more likely independently from drug treatment. Thus, the social isolation model might help to identify possible new therapeutic targets to treat the burden of chronic psychosocial stress and to attempt alternative therapy choices.
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Affiliation(s)
- Stefania Schiavone
- Department of Experimental and Clinical Medicine, University of Foggia Foggia, Italy
| | - Maria G Morgese
- Department of Experimental and Clinical Medicine, University of Foggia Foggia, Italy
| | - Emanuela Mhillaj
- Department of Physiology and Pharmacology, "Sapienza" University of Rome Rome, Italy
| | - Maria Bove
- Department of Physiology and Pharmacology, "Sapienza" University of Rome Rome, Italy
| | - Angelo De Giorgi
- Dual Diagnosis Unit, Azienda Sanitaria Locale della Provincia di Foggia Foggia, Italy
| | | | - Claudia Camerino
- Department of Physiology and Pharmacology, "Sapienza" University of RomeRome, Italy; Department of Basic Medical Science, Neuroscience and Sense Organs, University of BariBari, Italy
| | - Paolo Tucci
- Department of Experimental and Clinical Medicine, University of Foggia Foggia, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of SalernoSalerno, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and DentistryLondon, UK
| | - Vincenzo Cuomo
- Department of Physiology and Pharmacology, "Sapienza" University of Rome Rome, Italy
| | - Luigia Trabace
- Department of Experimental and Clinical Medicine, University of Foggia Foggia, Italy
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De Hert M, Detraux J, Stubbs B. Relationship between antipsychotic medication, serum prolactin levels and osteoporosis/osteoporotic fractures in patients with schizophrenia: a critical literature review. Expert Opin Drug Saf 2016; 15:809-23. [PMID: 26986209 DOI: 10.1517/14740338.2016.1167873] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Using an antipsychotic medication can increase prolactin (PRL) levels, causing hyperprolactinemia (HPRL). Although the occurrence of osteoporosis within the population of patients with schizophrenia has been recognized, the precise nature of the association between antipsychotic treatment, PRL, osteoporosis, and the disease itself seems to be elusive. AREAS COVERED The aim of this review is to critically review the literature regarding the association between osteoporosis and PRL and to summarize the available evidence with respect to the impact of PRL-elevating antipsychotics on bone mineral density (BMD) and fractures in non-elderly patients with schizophrenia. EXPERT OPINION Although long-standing HPRL can have an impact on the rate of bone metabolism and, when associated with hypogonadism, may lead to decreased bone density in both female and male subjects, the relative contribution of antipsychotic-induced HPRL in bone mineral loss in patients with schizophrenia remains unclear. Methodological shortcomings of existing studies, including the lack of prospective data and the focus on measurements of BMD instead of bone turnover markers, preclude definitive conclusions regarding the relationship between PRL-raising antipsychotics and BMD loss in patients with schizophrenia. Therefore, more well conducted prospective trials of these biomarkers are necessary to establish the precise relationship between antipsychotics, PRL levels and osteoporosis/osteoporotic risk.
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Affiliation(s)
- Marc De Hert
- a Department of Neurosciences , KU Leuven - University Psychiatric Centre , Kortenberg , Belgium
| | - Johan Detraux
- a Department of Neurosciences , KU Leuven - University Psychiatric Centre , Kortenberg , Belgium
| | - Brendon Stubbs
- b Physiotherapy Department , South London and Maudsley NHS Foundation Trust , Denmark Hill, London , United Kingdom.,c Health Service and Population Research Department , Institute of Psychiatry, King's College London , London , United Kingdom
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Malt EA, Juhasz K, Malt UF, Naumann T. A Role for the Transcription Factor Nk2 Homeobox 1 in Schizophrenia: Convergent Evidence from Animal and Human Studies. Front Behav Neurosci 2016; 10:59. [PMID: 27064909 PMCID: PMC4811959 DOI: 10.3389/fnbeh.2016.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 12/22/2022] Open
Abstract
Schizophrenia is a highly heritable disorder with diverse mental and somatic symptoms. The molecular mechanisms leading from genes to disease pathology in schizophrenia remain largely unknown. Genome-wide association studies (GWASs) have shown that common single-nucleotide polymorphisms associated with specific diseases are enriched in the recognition sequences of transcription factors that regulate physiological processes relevant to the disease. We have used a “bottom-up” approach and tracked a developmental trajectory from embryology to physiological processes and behavior and recognized that the transcription factor NK2 homeobox 1 (NKX2-1) possesses properties of particular interest for schizophrenia. NKX2-1 is selectively expressed from prenatal development to adulthood in the brain, thyroid gland, parathyroid gland, lungs, skin, and enteric ganglia, and has key functions at the interface of the brain, the endocrine-, and the immune system. In the developing brain, NKX2-1-expressing progenitor cells differentiate into distinct subclasses of forebrain GABAergic and cholinergic neurons, astrocytes, and oligodendrocytes. The transcription factor is highly expressed in mature limbic circuits related to context-dependent goal-directed patterns of behavior, social interaction and reproduction, fear responses, responses to light, and other homeostatic processes. It is essential for development and mature function of the thyroid gland and the respiratory system, and is involved in calcium metabolism and immune responses. NKX2-1 interacts with a number of genes identified as susceptibility genes for schizophrenia. We suggest that NKX2-1 may lie at the core of several dose dependent pathways that are dysregulated in schizophrenia. We correlate the symptoms seen in schizophrenia with the temporal and spatial activities of NKX2-1 in order to highlight promising future research areas.
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Affiliation(s)
- Eva A Malt
- Department of Adult Habilitation, Akershus University HospitalLørenskog, Norway; Institute of Clinical Medicine, Ahus Campus University of OsloOslo, Norway
| | - Katalin Juhasz
- Department of Adult Habilitation, Akershus University Hospital Lørenskog, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of OsloOslo, Norway; Department of Research and Education, Institution of Oslo University HospitalOslo, Norway
| | - Thomas Naumann
- Centre of Anatomy, Institute of Cell Biology and Neurobiology, Charite Universitätsmedizin Berlin Berlin, Germany
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, Del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 9:158-73. [PMID: 26927534 DOI: 10.1016/j.rpsm.2015.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 09/28/2015] [Accepted: 11/16/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Iatrogenic hyperprolactinaemia (IHPRL) has been more frequently related to some antipsychotic drugs that provoke an intense blockade of dopamine D2 receptors. There is a wide variation in clinical practice, and perhaps some more awareness between clinicians is needed. Due to the high frequency of chronic treatment in severe mental patients, careful attention is recommended on the physical risk. IHPRL symptoms could be underestimated without routine examination. METHODOLOGY An intense scientific literature search was performed in order to draw up a multidisciplinary consensus, including different specialists of psychiatry, endocrinology, oncology and internal medicine, and looking for a consensus about clinical risk and detection of IHPRL following evidence-based medicine criteria levels (EBM I- IV). RESULTS Short-term symptoms include amenorrhea, galactorrhoea, and sexual dysfunction with decrease of libido and erectile difficulties related to hypogonadism. Medium and long-term symptoms related to oestrogens are observed, including a decrease bone mass density, hypogonadism, early menopause, some types of cancer risk increase (breast and endometrial), cardiovascular risk increase, immune system disorders, lipids, and cognitive dysfunction. Prolactin level, gonadal hormones and vitamin D should be checked in all patients receiving antipsychotics at baseline although early symptoms (amenorrhea-galactorrhoea) may not be observed due to the risk of underestimating other delayed symptoms that may appear in the medium term. Routine examination of sexual dysfunction is recommended due to possible poor patient tolerance and low compliance. Special care is required in children and adolescents, as well as patients with PRL levels >50ng/ml (moderate hyperprolactinaemia). A possible prolactinoma should be investigated in patients with PRL levels >150ng/ml, with special attention to patients with breast/endometrial cancer history. Densitometry should be prescribed for males >50 years old, amenorrhea>6 months, or early menopause to avoid fracture risk.
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Affiliation(s)
- Ángel L Montejo
- Área de Neurociencias, Instituto de Biomedicina de Salamanca (IBSAL), Universidad de Salamanca, Servicio de Psiquiatría, Hospital Universitario de Salamanca, España.
| | - Celso Arango
- Departamento de Psiquiatría Infanto-Juvenil, Hospital General Universitario Gregorio Marañón (IiSGM). Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Miguel Bernardo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - José L Carrasco
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, CIBERSAM, Madrid, España
| | - Benedicto Crespo-Facorro
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria. Hospital Universitario Marqués de Valdecilla, IDIVAL, CIBERSAM, Santander, España
| | - Juan J Cruz
- Servicio de Oncología Médica, Hospital Universitario de Salamanca, Universidad de Salamanca (IBSAL), España
| | - Javier Del Pino
- Servicio Medicina Interna, Hospital Clínico Universitario, Universidad de Salamanca, España
| | | | - Clemente García Rizo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - Ana González-Pinto
- International Mood Disorders Research Centre, CIBERSAM, Hospital Santiago Apóstol, Universidad del País Vasco, Vitoria, España
| | - Ana I Hernández
- FEA Psiquiatría, Red de Salud Mental de Guipúzcoa, San Sebastián, España
| | - Manuel Martín Carrasco
- Instituto de Investigaciones Psiquiátricas, Fundación María Josefa Recio, Bilbao, España; Clínica Psiquiátrica Padre Menni, CIBERSAM, Pamplona, España
| | - Fermin Mayoral Cleries
- UGC Salud Mental, Hospital Regional Universitario, Instituto de Biomedicina de Málaga, Málaga, España
| | | | - M Teresa Mories
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Salamanca, España
| | - Isabella Pachiarotti
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
| | - Salvador Ros
- Instituto Internacional de Neurociencias Aplicadas, Barcelona, España
| | - Eduard Vieta
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
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16
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Liang Y, Huang J, Tian JB, Cao YY, Zhang GL, Wang CG, Cao Y, Li JR. Factors associated with decreased bone mineral density in postmenopausal women with schizophrenia. Clin Interv Aging 2016; 11:153-7. [PMID: 26937181 PMCID: PMC4762469 DOI: 10.2147/cia.s100274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study examined the risk factors for decreased bone mineral density (BMD) in postmenopausal women with schizophrenia. Methods Cluster sampling method was adopted in this large-sample, cross-sectional study. A total of 219 postmenopausal female inpatients with schizophrenia were selected and interviewed in Beijing. The average age of the patients was 60.4±7.0 years. Clinical assessment instruments included the Positive and Negative Syndrome Scale (PANSS) and a questionnaire with detailed general information and disease-related investigations. Laboratory measurements included prolactin (PRL), estradiol, progesterone, thyroid stimulating hormone, FT3, and FT4. BMD testing was performed by dual-energy X-ray absorptiometry. Results The prevalence of osteoporosis or osteopenia was 66.2% (n=145). Decreased BMD was associated with age, illness duration, therapeutic dose (equivalent chlorpromazine dose), treatment duration, PANSS-negative scores, body mass index (BMI), daily exercises (min/d), drinking (unit/wk), PRL, and estradiol. Multiple logistic regression analysis revealed that age, treatment duration, PANSS-negative score, BMI, and PRL were significantly associated with decreased BMD. Conclusion Prevalence of BMD loss was higher in Chinese postmenopausal women with schizophrenia compared to the normal BMD group. A combination of demographic and clinical factors play important roles in determining decreased BMD, including older age, longer treatment duration, more PANSS-negative scores, higher BMI, and higher PRL level.
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Affiliation(s)
- Ying Liang
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Institute of Mental Health, and the Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
| | - Jian Huang
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Institute of Mental Health, and the Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
| | - Jing-bin Tian
- Psychiatry Department, Changping District Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Yuan-yuan Cao
- Psychiatry Department, Changping District Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Guo-ling Zhang
- Psychiatry Department, Changping District Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Chun-gang Wang
- Psychiatry Department, Changping District Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Ying Cao
- Psychiatry Department, Changping District Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Jian-rong Li
- Psychiatry Department, Changping District Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
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Vitamin D status in psychotic disorder patients and healthy controls--The influence of ethnic background. Psychiatry Res 2015; 230:616-21. [PMID: 26500071 DOI: 10.1016/j.psychres.2015.10.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 01/20/2023]
Abstract
Vitamin D deficiency is common among patients with psychotic disorders and could be due to unknown disease mechanisms or contingent factors. However most studies are performed in chronic patients and have often failed to address the influence of ethnicity on vitamin D levels in clinical samples. We investigated serum concentrations of 25-hydroxy vitamin D (S-25 OH D) in first episode patients compared to patients with multi episodes and healthy controls; with a specific focus on differences between visible ethnic minorities and participants from the majority population. A total of 284 participants were included in this cross-sectional study. First episode patients with a DSM-IV psychotic disorder were matched on age, gender and ethnicity to participants from a multi episode patient sample (1:1) and healthy controls (1:2). We did not find any differences between either patient groups or the healthy controls, but participants from visible ethnic minorities had significantly lower S-25 OH D than participants from the majority population. This implies that S-25 OH D should be routinely measured in persons from visible ethnic minorities since low levels are associated with higher levels of depressive symptoms.
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Tseng PT, Chen YW, Yeh PY, Tu KY, Cheng YS, Wu CK. Bone Mineral Density in Schizophrenia: An Update of Current Meta-Analysis and Literature Review Under Guideline of PRISMA. Medicine (Baltimore) 2015; 94:e1967. [PMID: 26632691 PMCID: PMC5058960 DOI: 10.1097/md.0000000000001967] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Numerous reports have discussed bone mineral density (BMD) or the risk of osteoporosis in schizophrenia, but have yielded only controversial results.We conducted an update of meta-analysis to examine the overall change in BMD in patients with schizophrenia and the effect on BMD of different antipsychotic drugs.Electronic research through platform of PubMed.The inclusion criteria were as follows: articles with relevance to comparisons of BMD in patients with schizophrenia (SCHIZ) and healthy controls (HCs), or articles discussing comparisons of BMD in SCHIZ receiving prolactin-raising (PR) and prolactin-sparing (PS) antipsychotics; articles about clinical trials.In the current meta-analysis, we used the random-effect model to pool the results from 13 studies comparing BMD in SCHIZ and in HCs, and the results from 7 studies comparing BMD in patients receiving PR and PS.Our results revealed significantly lower BMD in SCHIZ than in HCs (P < 0.001). In the meta-regression, mean age of subjects modulated the difference in BMD between patients and control subjects (P < 0.001). In addition, the BMD in SCHIZ taking PR was significantly lower than in those taking PS (P = 0.006).Our study can only point to the phenomenon that BMD in SCHIZ is lower than that in HCs, and cannot reveal any possible pathophysiology or mechanism of this phenomenon. In addition, we could not rule out the possible effect of medication on BMD based on the results of the meta-analysis of comparison of BMD in SCHIZ receiving PR and PS.The main result of our meta-analysis suggests that BMD is significantly lower in SCHIZ than in HCs. Our study emphasizes the importance of further screening for the risk of osteoporosis in young-aged schizophrenic patients, especially those taking PR, which are in high risk of fracture.
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Affiliation(s)
- Ping-Tao Tseng
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home (PT, T, K-YT, Y-SC, C-KW), Department of Neurology, E-Da Hospital, Kaohsiung (YW, C), Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan (P-YY); and Department of Clinical Psychology, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan (P-YY)
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Bone Mineral Density as a Marker of Cumulative Estrogen Exposure in Psychotic Disorder: A 3 Year Follow-Up Study. PLoS One 2015; 10:e0136320. [PMID: 26309037 PMCID: PMC4550392 DOI: 10.1371/journal.pone.0136320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/02/2015] [Indexed: 11/19/2022] Open
Abstract
Altered estrogen-induced neuroprotection has been implicated in the etiology of psychotic disorders. Using bone mineral density as a marker of lifetime estrogen exposure, a longitudinal family study was conducted to discriminate between etiological mechanisms and secondary effects of disease and treatment. Dual X-ray absorptiometry scans were acquired twice, with an interval of 3 years, in 30 patients with psychotic disorder (male (M)/female (F): 24/6, mean age of 32 years at second measurement), 44 non-psychotic siblings of patients with a psychotic disorder (M/F: 26/18, mean age 32) and 27 controls (M/F: 7/20, mean age 35). Total bone mineral density, Z-scores and T-scores were measured in the lumbar spine and proximal femur. Associations between group and bone mineral density changes were investigated with multilevel random regression analyses. The effect of prolactin-raising antipsychotic medication was evaluated. (Increased risk of) psychotic disorder was not associated with disproportionate bone mineral density loss over a three year period. Instead, femoral bone mineral density measures appeared to decrease less in the patient versus control comparison (total BMD: B = 0.026, 95% CI 0.002 to 0.050, p = 0.037; Z-score: B = 0.224, 95% CI 0.035 to 0.412, p = 0.020; and T-score: B = 0.193, 95% CI 0.003 to 0.382, p = 0.046). Current or past use of a prolactin-raising antipsychotic medication was not associated with bone mineral density changes. In this small longitudinal study, there was no evidence of ongoing estrogen deficiency in psychotic disorder as there was no excessive loss of bone mineral density over a 3-year period in patients using antipsychotic medication.
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Williamson K, Kilner K, Clibbens N. A comparison of the nutrient intake of a community-dwelling first-episode psychosis cohort, aged 19-64 years, with data from the UK population. J Nutr Sci 2015; 4:e28. [PMID: 26495120 PMCID: PMC4611081 DOI: 10.1017/jns.2015.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/21/2014] [Accepted: 06/11/2015] [Indexed: 12/20/2022] Open
Abstract
Psychosis increases the risk of CVD, obesity and type 2 diabetes and reduces life expectancy. There are limited data comparing the dietary habits of community-dwelling first-episode psychosis sufferers - with autonomy over diet - and the general population. The data represent the retrospective evaluation of nutritional data collected between 2007 and 2013 from 143 individuals from the UK population receiving treatment for first-episode psychosis. Differences in mean nutrient intakes between the study cohort and the national sample were tested for statistical significance using independent t tests, incorporating Satterthwaite's correction where required. Mean total energy intake was lower for males (P = 0·049) and higher for females (P = 0·016) in the cohort than in the corresponding subgroups of the national sample. Females in the study cohort consumed 12·9 (95 % CI 4·3, 21·5) g more total fat per d, whilst males consumed 7·7 (95 % CI 0·5, 14·9) g less protein per d than the national sample. Males in the study also showed significantly lower mean intakes than nationally of folate, Fe, Se, vitamin D and Zn, but not vitamin C. The proportion of individuals not meeting the lower reference nutrient intakes, particularly for Se (males 54·0 % and females 57·1 %) and for Fe amongst females (29·6 %), is cause for concern regarding potentially severe deficiencies. Further exploration of dietary habits within first-episode psychosis is warranted to assess whether individuals make beneficial dietary changes for their physical and mental health and wellbeing following dietary change intervention. It would also be pertinent to assess any correlation between diet and mental health symptomology.
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Affiliation(s)
- Kevin Williamson
- Rotherham Early Intervention in Psychosis Service, Rotherham Doncaster and South Humber NHS Foundation Trust, 144A Aughton Road, Swallownest Court, Swallownest, Sheffield S26 4TH, UK
| | - Karen Kilner
- Sheffield Hallam University, P102 Montgomery House, 32 Collegiate Crescent, Sheffield S10 2BP, UK
| | - Nicola Clibbens
- Sheffield Hallam University, 36 Collegiate Crescent, Sheffield S10 2BP, UK
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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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O'Sullivan S, Grey A. Adverse skeletal effects of drugs - beyond Glucocorticoids. Clin Endocrinol (Oxf) 2015; 82:12-22. [PMID: 25039381 DOI: 10.1111/cen.12549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 06/28/2014] [Accepted: 07/07/2014] [Indexed: 12/13/2022]
Abstract
Osteoporotic fractures are an important public health problem with significant individual and societal costs. In addition to the major risk factors for osteoporotic fracture, low bone mineral density (BMD), age, low body weight and history of fracture or falls, some drugs are now considered to be important secondary risk factor for bone loss and fracture, particularly amongst predisposed individuals. Currently available data are often generated from small observational clinical studies, making risk assessment and development of management guidelines difficult. In many cases, the exposed population has a low baseline risk for fracture and additional assessment and treatment may not be necessary. In this review, we focus on drugs other than glucocorticoids identified as potentially causing adverse skeletal effects, summarizing the existing evidence from preclinical and clinical studies, and suggest recommendations for patient management.
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Abstract
In recent years, there have been reports suggesting a high prevalence of low vitamin D intakes and vitamin D deficiency or inadequate vitamin D status in Europe. Coupled with growing concern about the health risks associated with low vitamin D status, this has resulted in increased interest in the topic of vitamin D from healthcare professionals, the media and the public. Adequate vitamin D status has a key role in skeletal health. Prevention of the well-described vitamin D deficiency disorders of rickets and osteomalacia are clearly important, but there may also be an implication of low vitamin D status in bone loss, muscle weakness and falls and fragility fractures in older people, and these are highly significant public health issues in terms of morbidity, quality of life and costs to health services in Europe. Although there is no agreement on optimal plasma levels of vitamin D, it is apparent that blood 25-hydroxyvitamin D [25(OH)D] levels are often below recommended ranges for the general population and are particularly low in some subgroups of the population, such as those in institutions or who are housebound and non-Western immigrants. Reported estimates of vitamin D status within different European countries show large variation. However, comparison of studies across Europe is limited by their use of different methodologies. The prevalence of vitamin D deficiency [often defined as plasma 25(OH)D <25 nmol/l] may be more common in populations with a higher proportion of at-risk groups, and/or that have low consumption of foods rich in vitamin D (naturally rich or fortified) and low use of vitamin D supplements. The definition of an adequate or optimal vitamin D status is key in determining recommendations for a vitamin D intake that will enable satisfactory status to be maintained all year round, including the winter months. In most European countries, there seems to be a shortfall in achieving current vitamin D recommendations. An exception is Finland, where dietary survey data indicate that recent national policies that include fortification and supplementation, coupled with a high habitual intake of oil-rich fish, have resulted in an increase in vitamin D intakes, but this may not be a suitable strategy for all European populations. The ongoing standardisation of measurements in vitamin D research will facilitate a stronger evidence base on which policies can be determined. These policies may include promotion of dietary recommendations, food fortification, vitamin D supplementation and judicious sun exposure, but should take into account national, cultural and dietary habits. For European nations with supplementation policies, it is important that relevant parties ensure satisfactory uptake of these particularly in the most vulnerable groups of the population.
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Affiliation(s)
- A Spiro
- British Nutrition FoundationLondon, UK
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Stubbs B, De Hert M, Sepehry AA, Correll CU, Mitchell AJ, Soundy A, Detraux J, Vancampfort D. A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia. Acta Psychiatr Scand 2014; 130:470-86. [PMID: 25041606 DOI: 10.1111/acps.12313] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the prevalence and moderators of low bone mass, osteopenia and osteoporosis in schizophrenia patients. METHOD Major electronic databases were searched from inception till December 2013 for studies reporting the prevalence of low bone mass (osteopenia + osteoporosis = primary outcome), osteopenia or osteoporosis in schizophrenia patients. Two independent authors completed methodological appraisal and extracted data. A random effects meta-analysis was utilized. RESULTS Nineteen studies were included (n = 3038 with schizophrenia; 59.2% male; age 24.5-58.9 years). The overall prevalence of low bone mass was 51.7% (95% CI = 43.1-60.3%); 40.0% (CI = 34.7-45.4%) had osteopenia and 13.2% (CI = 7.8-21.6%) had osteoporosis. Compared with controls, schizophrenia patients had significantly increased risk of low bone mass (OR = 1.9, CI = 1.30-2.77, P < 0.001, n = 1872) and osteoporosis (OR = 2.86, CI = 1.27-6.42, P = 0.01, n = 1824), but not osteopenia (OR = 1.33, CI = 0.934-1.90, P = 0.1, n = 1862). In an exploratory regression analysis, older age (P = 0.004) moderated low bone mass, while older age (P < 0.0001) and male sex (P < 0.0001) moderated osteoporosis. The subgroup analyses demonstrated high heterogeneity, but low bone mass was less prevalent in North America (35.5%, CI = 26.6-45.2%) than Europe (53.6%, CI = 38.0-68.5%) and Asia (58.4%, CI = 48.4-67.7%), and in mixed in-/out-patients (32.9%, CI = 49.6-70.1%) vs. in-patients (60.3%, CI = 49.6-70.1%). CONCLUSION Reduced bone mass (especially osteoporosis) is significantly more common in people with schizophrenia than controls.
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Affiliation(s)
- B Stubbs
- School of Health and Social Care, University of Greenwich, London, UK
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25
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Clelland JD, Read LL, Drouet V, Kaon A, Kelly A, Duff KE, Nadrich RH, Rajparia A, Clelland CL. Vitamin D insufficiency and schizophrenia risk: evaluation of hyperprolinemia as a mediator of association. Schizophr Res 2014; 156:15-22. [PMID: 24787057 PMCID: PMC4044915 DOI: 10.1016/j.schres.2014.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 12/25/2022]
Abstract
25-Hydroxyvitamin D (25(OH)D) deficits have been associated with schizophrenia susceptibility and supplementation has been recommended for those at-risk. Although the mechanism by which a deficit confers risk is unknown, vitamin D is a potent transcriptional modulator and can regulate proline dehydrogenase (PRODH) expression. PRODH maps to chromosome 22q11, a region conferring the highest known genetic risk of schizophrenia, and encodes proline oxidase, which catalyzes proline catabolism. l-Proline is a neuromodulator at glutamatergic synapses, and peripheral hyperprolinemia has been associated with decreased IQ, cognitive impairment, schizoaffective disorder, and schizophrenia. We investigated the relationship between 25(OH)D and schizophrenia, comparing fasting plasma 25(OH)D in 64 patients and 90 matched controls. We then tested for a mediating effect of hyperprolinemia on the association between 25(OH)D and schizophrenia. 25(OH)D levels were significantly lower in patients, and 25(OH)D insufficiency associated with schizophrenia (OR 2.1, adjusted p=0.044, 95% CI: 1.02-4.46). Moreover, 25(OH)D insufficient subjects had three times greater odds of hyperprolinemia than those with optimal levels (p=0.035, 95% CI: 1.08-8.91), and formal testing established that hyperprolinemia is a significantly mediating phenotype that may explain over a third of the effect of 25(OH)D insufficiency on schizophrenia risk. This study presents a mechanism by which 25(OH)D insufficiency confers risk of schizophrenia; via proline elevation due to reduced PRODH expression, and a concomitant dysregulation of neurotransmission. Although definitive causality cannot be confirmed, these findings strongly support vitamin D supplementation in patients, particularly for those with elevated proline, who may represent a large subgroup of the schizophrenia population.
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Affiliation(s)
- James D. Clelland
- Movement Disorders and Molecular Psychiatry. The Nathan Kline Institute for Psychiatric Research. 140 Old Orangeburg Road. Orangeburg. NY,Department of Psychiatry, New York University Langone Medical Center, 550 First Avenue. New York, NY
| | - Laura L. Read
- Movement Disorders and Molecular Psychiatry. The Nathan Kline Institute for Psychiatric Research. 140 Old Orangeburg Road. Orangeburg. NY,Department of Psychiatry, New York University Langone Medical Center, 550 First Avenue. New York, NY
| | - Valérie Drouet
- Department of Pathology and Cell Biology, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain. Columbia University Medical Center. 630 West 168th Street. New York
| | - Angela Kaon
- Movement Disorders and Molecular Psychiatry. The Nathan Kline Institute for Psychiatric Research. 140 Old Orangeburg Road. Orangeburg. NY
| | - Alexandra Kelly
- Department of Pathology and Cell Biology, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain. Columbia University Medical Center. 630 West 168th Street. New York
| | - Karen E. Duff
- Department of Pathology and Cell Biology, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain. Columbia University Medical Center. 630 West 168th Street. New York,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY
| | - Robert H Nadrich
- Department of Psychiatry, New York University Langone Medical Center, 550 First Avenue. New York, NY,Bellevue Hospital Center, 462 First Avenue, New York, NY
| | - Amit Rajparia
- Department of Psychiatry, New York University Langone Medical Center, 550 First Avenue. New York, NY,Bellevue Hospital Center, 462 First Avenue, New York, NY
| | - Catherine L. Clelland
- Department of Pathology and Cell Biology, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain. Columbia University Medical Center. 630 West 168th Street. New York
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Wang M, Hou R, Jian J, Mi G, Qiu H, Cao B, Tang M. Effects of antipsychotics on bone mineral density and prolactin levels in patients with schizophrenia: a 12-month prospective study. Hum Psychopharmacol 2014; 29:183-9. [PMID: 24738111 DOI: 10.1002/hup.2387] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Effects of conventional and atypical antipsychotics on bone mineral density (BMD) and serum prolactin levels (PRL) were examined in patients with schizophrenia. METHODS One hundred and sixty-three first-episode inpatients with schizophrenia were recruited, to whom one of three conventional antipsychotics (perphenazine, sulpiride, and chlorpromazine) or one of three atypical antipsychotics (clozapine, quetiapine, and aripiprazole) was prescribed for 12 months as appropriate. BMD and PRL were tested before and after treatment. Same measures were conducted in 90 matched healthy controls. RESULTS Baseline BMD of postero-anterior L1-L4 range from 1.04 ± 0.17 to 1.42 ± 1.23, and there was no significant difference between the patients group and healthy control group. However, post-treatment BMD values in patients (ranging from 1.02 ± 0.15 to 1.23 ± 0.10) were significantly lower than that in healthy controls (ranging from 1.15 ± 0.12 to 1.42 ± 1.36). The BMD values after conventional antipsychotics were significantly lower than that after atypical antipsychotics. The PRL level after conventional antipsychotics (53.05 ± 30.25 ng/ml) was significantly higher than that after atypical antipsychotics (32.81 ± 17.42 ng/ml). Conditioned relevance analysis revealed significant negative correlations between the PRL level and the BMD values after conventional antipsychotics. CONCLUSION The increase of PRL might be an important risk factor leading to a high prevalence of osteoporosis in patients with schizophrenia on long-term conventional antipsychotic medication.
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Affiliation(s)
- Mengxin Wang
- Shandong University Qilu Hospital; Jinan Shandong China
| | - Ruihua Hou
- Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine; University of Southampton; Southampton United Kingdom
| | - Jia Jian
- Shandong Mental Health Center; Jinan Shandong China
| | - Guolin Mi
- Shandong Mental Health Center; Jinan Shandong China
| | - Huimin Qiu
- Shandong Mental Health Center; Jinan Shandong China
| | - Bingyu Cao
- Shandong Mental Health Center; Jinan Shandong China
| | - Maoqin Tang
- Shandong Mental Health Center; Jinan Shandong China
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Dealberto MJ. Clinical symptoms of psychotic episodes and 25-hydroxy vitamin D serum levels in black first-generation immigrants. Acta Psychiatr Scand 2013; 128:475-87. [PMID: 23405850 DOI: 10.1111/acps.12086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Dark-skinned immigrants have a higher risk for schizophrenia and other psychoses than other immigrants. The first British studies reported that first-generation immigrants (FGIs) from the Caribbean presented atypical psychoses. This study examines the characteristics of psychotic episodes in black FGIs to Canada. METHOD The charts of 18 FGIs from Africa and Haiti, extracted from a series of 20 black patients consecutively admitted to Psychiatry, were retrospectively reviewed regarding clinical features, diagnoses and vitamin D levels. RESULTS Young FGIs presented acute psychotic episodes with abrupt onset, florid positive symptoms, few negative symptoms and good evolution. The onset was more insidious in older FGIs. Overall, catatonia was very frequent (28%), and mood symptoms still more frequent (44%). No cognitive decline was observed during follow-up. Serum levels of 25-hydroxy vitamin D were in the insufficiency range. Supplementation at 1000 IU/day did not restore normal levels. CONCLUSION The clinical features of psychotic episodes in black FGIs are similar to those reported in dark-skinned FGIs to other countries. They are also observed in other immigrants and in non-immigrants. These atypical psychoses are possibly related to a recent vitamin D deficit. This hypothesis should be tested by clinical trials of sufficient vitamin D supplementation.
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Affiliation(s)
- M-J Dealberto
- Department of Community Health and Epidemiology, Carruthers Hall, Queen's University, Kingston, Ontario, K7L 3N6, Canada
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Belvederi Murri M, Respino M, Masotti M, Innamorati M, Mondelli V, Pariante C, Amore M. Vitamin D and psychosis: mini meta-analysis. Schizophr Res 2013; 150:235-9. [PMID: 23906618 DOI: 10.1016/j.schres.2013.07.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/17/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
Individuals with psychotic disorders are more likely to have vitamin D (VD) deficiency, while evidence suggests VD could have pathophysiological roles. We summarized meta-analytically the available evidence on VD levels in psychotic disorders in comparison with healthy controls and other psychiatric illnesses. We found seven studies, all reporting insufficient VD levels in patients with psychosis. Schizophrenia had a medium effect size for lower VD than healthy controls, and a trend for lower levels than other psychoses. There were non-significant differences between schizophrenia and major depression. No study has investigated the potential psychotropic effects of VD supplementation in patients with psychosis.
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Affiliation(s)
- Martino Belvederi Murri
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy; King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK.
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Abstract
Vitamin D deficiency is associated with osteoporosis and is thought to increase the risk of cancer and CVD. Despite these numerous potential health effects, data on vitamin D status at the population level and within key subgroups are limited. The aims of the present study were to examine patterns of 25-hydroxyvitamin D (25(OH)D) levels worldwide and to assess differences by age, sex and region. In a systematic literature review using the Medline and EMBASE databases, we identified 195 studies conducted in forty-four countries involving more than 168 000 participants. Mean population-level 25(OH)D values varied considerably across the studies (range 4·9-136·2 nmol/l), with 37·3 % of the studies reporting mean values below 50 nmol/l. The highest 25(OH)D values were observed in North America. Although age-related differences were observed in the Asia/Pacific and Middle East/Africa regions, they were not observed elsewhere and sex-related differences were not observed in any region. Substantial heterogeneity between the studies precluded drawing conclusions on overall vitamin D status at the population level. Exploratory analyses, however, suggested that newborns and institutionalised elderly from several regions worldwide appeared to be at a generally higher risk of exhibiting lower 25(OH)D values. Substantial details on worldwide patterns of vitamin D status at the population level and within key subgroups are needed to inform public health policy development to reduce risk for potential health consequences of an inadequate vitamin D status.
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Sørensen HJ, Jensen SOW, Nielsen J. Schizophrenia, antipsychotics and risk of hip fracture: a population-based analysis. Eur Neuropsychopharmacol 2013; 23:872-8. [PMID: 23642346 DOI: 10.1016/j.euroneuro.2013.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/24/2013] [Accepted: 04/02/2013] [Indexed: 11/26/2022]
Abstract
In a nationwide study using linkage of Danish hospital registers we examined predictors of hip fracture (ICD-10: S72) in 15,431 patients with schizophrenia (ICD-10: F20 or ICD-8: 295) and 3,807,597 population controls. Shorter education, disability pension, lifetime alcohol abuse, somatic co-morbidity, antipsychotics (IRR=1.19; 95% CI 1.15-1.24), antidepressant (IRR=1.18; 95% CI 1.16-1.20), anticholinergics (IRR=1.29; 95% CI 1.22-1.36), benzodiazepines (IRR=1.06; 95% CI 1.04-1.08) and corticosteroids (IRR=1.44; 95% CI 1.36-1.53) were significant predictors. In 556 persons with schizophrenia and hip fracture (matched to 1:3 to schizophrenia controls without hip fracture), antipsychotic polypharmacy predicted hip fracture. Analyses among antipsychotic monotherapy patients showed no differential effect of individual antipsychotics. A dose-response relationship of hip fracture and lifetime antipsychotics consumption was found (IRR=1.13 95% CI 1.07-1.19) and both prolactin-increasing and non-prolactin-increasing antipsychotics contributed to the effect. In conclusion, several factors, including complex psychopharmacological treatment, contribute in the prediction of hip fracture in large populations. Preventive strategies should focus attention to severely ill patients with high likelihood of a receiving complex psychopharmacologic treatment and high doses of antipsychotics.
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Affiliation(s)
- Holger J Sørensen
- Centre for Schizophrenia, Aalborg Psychiatric Hospital, Aarhus University Hospital, Brandevej 5, 9220 Aalborg Øst, Denmark
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Williams LJ, Pasco JA, Jacka FN, Hodge JM, Kotowicz MA, Berk M. Quantitative Heel Ultrasound (QUS) measures of bone quality in association with mood and anxiety disorders. J Affect Disord 2013; 146:395-400. [PMID: 23122528 DOI: 10.1016/j.jad.2012.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 09/26/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The common mental disorders are potential risk factors for low bone mass as a result of disease and/or medication-related processes. Quantitative heel ultrasound (QUS) is a portable and relatively cheap screening tool for determining fracture risk. Thus, we investigated the association between QUS parameters, mood and anxiety disorders in a population-based sample of 745 men and 897 women. METHODS Using a clinical interview (SCID-I/NP), mood and anxiety disorders were identified. Bone quality was established using QUS and included the following parameters: Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS) and Stiffness Index (SI). Anthropometry, socio-economic status (SES), medication use and lifestyle factors were determined. RESULTS In men, mood and anxiety disorders were associated with lower age-weight- and smoking-adjusted SOS, BUA and SI. In women, age was an effect modifier. Among younger women (≤ 40yr), mood disorders were associated with lower age-weight- and smoking-adjusted SOS and SI but not BUA. No differences were detected in older women or women with anxiety disorders. These patterns persisted after adjustment for activity, alcohol, calcium intake, SES and medications. LIMITATIONS Cross-sectional study design, and possible residual or unrecognised confounding. CONCLUSION Our data suggest that bone quality, as measured by QUS, is reduced among men and younger women with a history of mood disorders. Furthermore, an inverse association between anxiety disorders and bone quality was evident for men. Thus, QUS may be a useful screening tool for determining fracture risk within these populations.
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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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van der Leeuw C, Habets P, Domen P, van Kroonenburgh M, van Os J, Marcelis M. Bone mineral density as a marker of cumulative endogenous estrogen exposure: relationship to background genetic risk of psychotic disorder. Schizophr Res 2013. [PMID: 23194650 DOI: 10.1016/j.schres.2012.10.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Alterations in bone mineral density (BMD) in patients with psychotic disorder may reflect the effect of treatment (disease effect observed in patients but not their siblings) or, as an intermediate marker of cumulative endogenous estrogen exposure, alterations in the neuroprotective effect of estrogen in the brain (vulnerability effect observed in patients and siblings). METHODS Dual X-ray absorptiometry (DEXA) scans were acquired in 62 patients with a psychotic disorder, 67 non-psychotic siblings of patients with a psychotic disorder, and 48 controls. BMD (g/cm(2)), Z-scores and T-scores were measured in the lumbar spine and proximal femur. Associations between group and BMD were investigated with multilevel random regression analyses. Group×sex interactions and effects of antipsychotic medication (AP) on BMD were examined. RESULTS Group was not associated with BMD outcome measures, although patients had consistently lower BMD measures compared to both siblings and controls. There were no significant group×sex interactions, but stratified analyses showed that BMD measures in female patients were significantly lower in comparison to female controls and siblings (e.g. total femoral BMD, P vs. C: B=-0.100, p=0.010; P vs. S: B=-0.104, p=0.008). After excluding female patients who used prolactin-raising AP, the effect was attenuated (e.g. total femoral BMD, P vs. C: B=-0.073, p=0.072; P vs. S: B=-0.085, p=0.051). In men, there were no significant BMD differences between patients and controls. CONCLUSION Familial risk of psychotic disorder was not associated with BMD. Instead, decreased BMD in the femur may reflect treatment effects or non-familial risk associated with low cumulative endogenous estrogen levels in women.
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Affiliation(s)
- C van der Leeuw
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, PO Box 616, 6200 MD Maastricht, The Netherlands
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Abstract
PURPOSE OF REVIEW Excessive bone mineral density (BMD) loss has been associated with schizophrenia, but its mechanisms and clinical implications are less clear. The aim of this review was to summarize the risk of osteoporosis and bone fractures in schizophrenia patients. Moreover, we aimed to examine the impact of antipsychotic-induced hyperprolactinemia on bone metabolism. RECENT FINDINGS Fifteen of 16 studies (93.8%) reported lower BMD or higher prevalence of osteoporosis in at least one region, or in at least one subgroup of schizophrenia patients compared with controls, but results were inconsistent across measured areas. Higher fracture risk was associated with schizophrenia in 2/2 studies (independently: n = 1), and 3/4 studies with antipsychotics. Reasons for this difference include insufficient exercise, poor nutrition, smoking, alcohol use, and low vitamin D levels. Altogether, 9/15 (60.0%) studies examining the relationship between antipsychotic-induced hyperprolactinemia and BMD loss found some effects of hyperprolactinemia. However, results were mixed, samples and effects were small, and only two studies were prospective. SUMMARY Schizophrenia is associated with reduced BMD and fracture risk. Prevention, early detection, and intervention are required. The relative contributions of antipsychotic-related hyperprolactinemia and unhealthy lifestyle behaviors remain unclear, needing to be assessed in well designed, prospective studies, including bone turnover markers as intermediary endpoints.
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Affiliation(s)
- Taishiro Kishimoto
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
- Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Marc De Hert
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Harold E. Carlson
- Endocrinology Division, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Peter Manu
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
- Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- Transilvania University, Brasov, Romania
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
- Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
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Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, Josse R, Kanis JA, Mithal A, Pierroz DD, Stenmark J, Stöcklin E, Dawson-Hughes B. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012; 7:155-72. [PMID: 23225293 DOI: 10.1007/s11657-012-0093-0] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/06/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE This paper visualizes the available data on vitamin D status on a global map, examines the existing heterogeneities in vitamin D status and identifies research gaps. METHODS A graphical illustration of global vitamin D status was developed based on a systematic review of the worldwide literature published between 1990 and 2011. Studies were eligible if they included samples of randomly selected males and females from the general population and assessed circulating 25-hydroxyvitamin D [25(OH)D] levels. Two different age categories were selected: children and adolescents (1-18 years) and adults (>18 years). Studies were chosen to represent a country based on a hierarchical set of criteria. RESULTS In total, 200 studies from 46 countries met the inclusion criteria, most coming from Europe. Forty-two of these studies (21 %) were classified as representative. In children, gaps in data were identified in large parts of Africa, Central and South America, Europe, and most of the Asia/Pacific region. In adults, there was lack of information in Central America, much of South America and Africa. Large regions were identified for which the mean 25(OH)D levels were below 50 nmol/L. CONCLUSIONS This study provides an overview of 25(OH)D levels around the globe. It reveals large gaps in information in children and adolescents and smaller but important gaps in adults. In view of the importance of vitamin D to musculoskeletal growth, development, and preservation, and of its potential importance in other tissues, we strongly encourage new research to clearly define 25(OH)D status around the world.
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Affiliation(s)
- D A Wahl
- International Osteoporosis Foundation, Nyon, Switzerland
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36
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Tani H, Uchida H, Suzuki T, Shibuya Y, Shimanuki H, Watanabe K, Den R, Nishimoto M, Hirano J, Takeuchi H, Nio S, Nakajima S, Kitahata R, Tsuboi T, Tsunoda K, Kikuchi T, Mimura M. Dental conditions in inpatients with schizophrenia: a large-scale multi-site survey. BMC Oral Health 2012; 12:32. [PMID: 22901247 PMCID: PMC3466126 DOI: 10.1186/1472-6831-12-32] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 08/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical relevance of dental caries is often underestimated in patients with schizophrenia. The objective of this study was to examine dental caries and to identify clinical and demographic variables associated with poor dental condition in patients with schizophrenia. METHODS Inpatients with schizophrenia received a visual oral examination of their dental caries, using the decayed-missing-filled teeth (DMFT) index. This study was conducted in multiple sites in Japan, between October and December, 2010. A univariate general linear model was used to examine the effects of the following variables on the DMFT score: age, sex, smoking status, daily intake of sweets, dry mouth, frequency of daily tooth brushing, tremor, the Clinical Global Impression-Schizophrenia Overall severity score, and the Cumulative Illness Rating Scale for Geriatrics score. RESULTS 523 patients were included in this study (mean ± SD age = 55.6 ± 13.4 years; 297 men). A univariate general linear model showed significant effects of age group, smoking, frequency of daily tooth brushing, and tremor (all p's < 0.001) on the DMFT score (Corrected Model: F(23, 483) = 3.55, p < 0.001, R2 = 0.42) . In other words, older age, smoking, tremor burden, and less frequent tooth brushing were associated with a greater DMFT score. CONCLUSIONS Given that poor dental condition has been related with an increased risk of physical co-morbidities, physicians should be aware of patients' dental status, especially for aged smoking patients with schizophrenia. Furthermore, for schizophrenia patients who do not regularly brush their teeth or who exhibit tremor, it may be advisable for caregivers to encourage and help them to perform tooth brushing more frequently.
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Affiliation(s)
- Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Tolppanen AM, Sayers A, Fraser WD, Lewis G, Zammit S, Lawlor DA. The association of 25-hydroxyvitamin D3 and D2 with behavioural problems in childhood. PLoS One 2012; 7:e40097. [PMID: 22808099 PMCID: PMC3393748 DOI: 10.1371/journal.pone.0040097] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/31/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Higher serum concentrations of 25-hydroxyvitamin D (25(OH)D), an indicator of vitamin D synthesis and intake, have been associated with better mental health and cognitive function. Concentrations of 1,25-dihydroxyvitamin D(3) (the active vitamin D(3) metabolite) have been associated with openness and extrovert behaviour, but 25(OH)D concentrations have not been associated with behavioural problems in humans. METHODS We investigated the prospective association between the different forms of 25(OH)D - 25(OH)D(3) and 25(OH)D(2)- and childhood behavioural problems in Avon Longitudinal Study of Parents and Children (ALSPAC). Serum 25(OH)D(3) and 25(OH)D(2) concentrations were assessed at mean age 9.9 years. Incident behavioural problems were assessed with Strengths and Difficulties Questionnaire (SDQ; emotional symptoms, conduct problems, hyperactivity-inattention problems, peer relationship problems and pro-social behaviour subscales and total difficulties score) at mean age 11.7. Sample sizes varied between 2413-2666 depending on the outcome. RESULTS Higher 25(OH)D(3) concentrations were weakly associated with lower risk of prosocial problems (fully adjusted odds ratio: OR (95% confidence interval: CI) 0.85 (0.74, 0.98)). Serum 25(OH)D(3) or 25(OH)D(2) concentrations were not associated with other subscales of SDQ or total difficulties score after adjusting for concfounders and other measured analytes related to vitamin D. CONCLUSIONS Our findings do not support the hypothesis that 25-hydroxyvitamin D status in childhood has important influences on behavioural traits in humans.
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Affiliation(s)
- Anna-Maija Tolppanen
- Medical Research Council Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Adrian Sayers
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - William D. Fraser
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Stanley Zammit
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Medical Research Council Centre Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Debbie A. Lawlor
- Medical Research Council Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
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Crews MPK, Howes OD. Is antipsychotic treatment linked to low bone mineral density and osteoporosis? A review of the evidence and the clinical implications. Hum Psychopharmacol 2012; 27:15-23. [PMID: 22228316 PMCID: PMC3731625 DOI: 10.1002/hup.1265] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 11/19/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Osteoporosis is increasingly common worldwide and there is a growing concern that the long-term use of antipsychotic medications increases the risk of this disorder. In this review, we consider whether antipsychotics may contribute to the development of osteoporosis through reductions in bone mineral density, discuss the possible mechanisms involved and consider the clinical implications of such a relationship. METHODS We searched the literature for studies in this area published between 1966 and 2010 using the Medline and PubMed databases, supplemented by hand searches of retrieved reports. RESULTS The available data indicate that statistically significant reductions in bone mineral density are frequently seen in patients prescribed with antipsychotic medications and suggest that there is a higher incidence of clinically significant reductions compared with the normal population. CONCLUSIONS Clinicians should be aware for the potential negative effects of antipsychotic medications on bone mineral density, particularly in patients with additional risk factors for osteoporosis. Recommendations regarding routine monitoring of bone mineral density for patients prescribed antipsychotic medications cannot be made on the basis of existing evidence, and more research is required.
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Affiliation(s)
- Matthieu P K Crews
- South London and Maudsley NHS Foundation Trust, The Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - Oliver D Howes
- King’s College London- Institute of Psychiatry, King’s Health Partners, De Crespigny Park, Camberwell, London, SE5 8AF, UK
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Psychosis-induced vitamin D deficiency with secondary hyperparathyroidism and osteoporotic fractures. Gen Hosp Psychiatry 2011; 33:641.e3-5. [PMID: 21762996 DOI: 10.1016/j.genhosppsych.2011.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/19/2011] [Accepted: 05/22/2011] [Indexed: 11/24/2022]
Abstract
Vitamin D deficiency is common in patients with insufficient sunlight exposure and nutritional deficit in calcium and vitamin D. We present a patient with vitamin D deficiency, secondary hyperparathyroidism and resulting osteoporotic fractures caused or supported by psychosis-induced minimal sunlight exposure and nutritional deficits. To our knowledge, this is the first case where delusional ideas could have led to a vitamin D deficiency, secondary hyperparathyroidism and osteoporotic fractures. Similar clinical cases could be more often, but significantly underdiagnosed, among schizophrenia patients. An appropriate prevention by UV light exposure, food fortification and supplements is normally sufficient for patients at risk.
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