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Carney R, Imran S, Law H, Carmichael-Murphy P, Charlton L, Parker S. "If you're struggling, you don't really care" - what affects the physical health of young people on child and adolescent mental health inpatient units? A qualitative study with service users and staff. BMC Psychiatry 2024; 24:498. [PMID: 38982436 PMCID: PMC11234625 DOI: 10.1186/s12888-024-05858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 05/21/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15-20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. METHODS We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14-42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. . RESULTS Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. CONCLUSIONS Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.
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Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Shermin Imran
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, M13 3BL, UK
| | - Heather Law
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Parise Carmichael-Murphy
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Leah Charlton
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
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Lyu N, Abughosh S, Varisco TJ, Lin Y, Rowan PJ, Chen H. Group-Based Trajectory Modeling to Identify Patterns of Antipsychotic-Associated Weight Gain Among Children and Adolescents. J Clin Psychopharmacol 2024; 44:124-132. [PMID: 38259102 DOI: 10.1097/jcp.0000000000001814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
PURPOSE/BACKGROUND Antipsychotic-associated weight gain (AAWG) is a common adverse effect of second-generation antipsychotic (SGA) medications among children and adolescents. This study applied group-based trajectory modeling to identify latent trajectories of AAWG among children and adolescents and associated risk factors. PROCEDURES This was a retrospective analysis of the IQVIA Ambulatory EMR-US database from 2016 to 2021. The cohort consisted of patients aged 6 to 19 years who were SGA naive and received at least 90 days of continuous SGA prescriptions. Group-based trajectory modeling was used to identify latent trajectories of AAWG development during a 24-month period since SGA initiation, and multinomial logistic regression analysis was conducted to examine the risk factors associated with the identified AAWG trajectories. FINDINGS/RESULTS A total of 16,262 patients were included. Group-based trajectory modeling identified the following 4 distinctive AAWG trajectories: persistent severe weight gain (4.2%), persistent moderate weight gain (20.1%), minor weight change (69.6%), and gradual weight loss (6.1%). Compared with the minor weight change group, younger age (12-17 vs 5-11: odds ratio [OR], 0.634; 95% confidence interval [CI], 0.521-0.771), lower baseline body mass index z -score (OR, 0.216; 95% CI, 0.198-0.236), and receiving olanzapine as the initial SGA (olanzapine vs aripiprazole: OR, 1.686; 95% CI, 1.673-1.699) were more likely to follow severe weight gain trajectories. The area under the receiver operating characteristic curves for comparing severe weight gain versus minor weight change groups and moderate weight vs minor weight change groups in the multinomial regression model were 0.91 and 0.8, respectively. IMPLICATIONS/CONCLUSIONS A quarter of pediatric SGA recipients experienced persistent weight gain during the SGA treatment. The risk of having persistent AAWG can be predicted using patient characteristics collected before SGA initiation and the initial SGA agent.
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Affiliation(s)
- Ning Lyu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston
| | - Susan Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston
| | - Tyler J Varisco
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston
| | - Ying Lin
- Department of Industrial Engineering, College of Engineering, University of Houston, Houston
| | - Paul J Rowan
- Division of Management, Policy and Community Health, School of Public Health, University of Texas at Houston, Houston, TX
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston
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DelBello MP, Bruns KM, Bloom T, Patino Duran LR, Strawn J, Adler CM, Welge J. A Double-Blind Placebo-Controlled Pilot Study of Topiramate in Manic Adolescents Treated with Olanzapine. J Child Adolesc Psychopharmacol 2023; 33:126-133. [PMID: 37130314 DOI: 10.1089/cap.2022.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Objective: To conduct a pilot study to examine topiramate for the treatment of weight gain associated with olanzapine in manic adolescents with bipolar disorder. Methods: We conducted a 12-week double-blind randomized placebo-controlled pilot study of topiramate (300-400 mg/day) versus placebo in manic youth (ages 10-18 years) with bipolar disorder who were treated with olanzapine (10-20 mg/day). The primary outcome measure was gender- and weight-normed change in body mass index (BMI z-score). Results: Thirty manic adolescents were treated with olanzapine and were randomized to either topiramate (n = 16) or placebo (n = 14). There was a significantly greater increase in BMI z-scores in the placebo group (0.28 standard deviations [SDs]) compared with the topiramate group (0.10 SDs) when analyzed by longitudinal regression (p = 0.049). The placebo group had greater increases in raw BMI and weight (2.25 kg/m2 and 6.9 kg, respectively) compared with the topiramate (0.99 kg/m2 and 2.9 kg) group (p = 0.011 for BMI, p = 0.016 for weight). The most common adverse events in the topiramate group were headache (n = 7, 44%), gastrointestinal upset (n = 3, 19%), and muscle stiffness (n = 3, 19%). Conclusions: Topiramate may minimize the weight gain associated with olanzapine treatment in adolescents with bipolar disorder. Moreover, topiramate in combination with olanzapine was well tolerated. Larger studies that are adequately powered are necessary to determine the efficacy of topiramate for second-generation antipsychotic-related weight gain. Trial Registration: ClinicalTrials.gov Identifier number NCT00394095.
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Affiliation(s)
- Melissa P DelBello
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kaitlyn M Bruns
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Thomas Bloom
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Luis Rodrigo Patino Duran
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey Strawn
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Caleb M Adler
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey Welge
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Haghshenas M, Arman S. Metabolic effects of adding Topiramate on Aripiprazole in bipolar patients aged between 6-18 years, a randomized, double-blind, placebo-controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:23. [PMID: 35419064 PMCID: PMC8995310 DOI: 10.4103/jrms.jrms_672_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/26/2021] [Accepted: 12/11/2021] [Indexed: 11/04/2022]
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Penfold RB, Thompson EE, Hilt RJ, Schwartz N, Robb AS, Correll CU, Newton D, Rogalski K, Earls MF, Kowatch RA, Beck A, Yarborough BJH, Crystal S, Vitiello B, Kelleher KJ, Simon GE. Development of a Symptom-Focused Model to Guide the Prescribing of Antipsychotics in Children and Adolescents: Results of the First Phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:93-102. [PMID: 34256967 PMCID: PMC8566327 DOI: 10.1016/j.jaac.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop a new approach to prescribing guidelines as part of a pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.
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Affiliation(s)
- Robert B Penfold
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle.
| | - Ella E Thompson
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle
| | - Robert J Hilt
- Dr. Hilt is with Seattle Children's Hospital, Washington
| | - Nadine Schwartz
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Adelaide S Robb
- Dr. Robb is with Children's National Hospital, Washington, DC
| | - Christoph U Correll
- Dr. Correll is with The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; The Feinstein Institute for Medical Research, Manhasset, New York; and Charité Universitätsmedizin Berlin, Germany
| | - Douglas Newton
- Dr. Newton is with Sondermind, Denver, Colorado. At the time of the study, Dr. Newton was with Optum Behavioral Health, Denver, Colorado
| | - Kelly Rogalski
- Dr. Rogalski is with Henry Ford Health System, Detroit, Michigan
| | - Marian F Earls
- Dr. Earls is with Community Care of North Carolina, Raleigh
| | - Robert A Kowatch
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Arne Beck
- Dr. Beck is with Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Bobbi Jo H Yarborough
- Dr. Yarborough is with Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Stephen Crystal
- Dr. Crystal is with Rutgers University, Brunswick, New Jersey
| | | | - Kelly J Kelleher
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Gregory E Simon
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle
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Carney R, Firth J. Exercise interventions in child and adolescent mental health care: An overview of the evidence and recommendations for implementation. JCPP ADVANCES 2021; 1:e12031. [PMID: 37431402 PMCID: PMC10242844 DOI: 10.1002/jcv2.12031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background The use of physical activity interventions in mental health care for adults has a large academic evidence base and numerous examples of real-world implementation. However, the use of physical activity within mental health care for children and young people (CYP) has received less attention to date. Methods A narrative review was conducted to summarize the relevant literature in the area. Online databases were searched using terms synonymous with CYP, exercise, physical health, and mental health. Findings from existing systematic reviews, meta-analyses, meta-syntheses, and consensus statements were reviewed, and used alongside the authors' experience to inform clinical recommendations. Results We first discuss the importance of applying physical health interventions in early stages of mental illness for CYP to prevent physical comorbidities and premature mortality in the long term. We then provide a brief summary of the current evidence of the benefits of exercise interventions in CYP with mental illness. We then present our top five recommendations on the implementation of exercise interventions within CYP mental health care. Conclusion The key conclusions from this suggest there is an increasingly strong evidence base for the benefits of using physical activity interventions to improve, prevent, and manage physical and mental health outcomes in CYP with mental illness. However, more work needs to be done to improve the evidence base, refine its implementation into standard mental health care, and develop strategies for large-scale dissemination of such interventions across various care and cultural contexts.
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Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
- Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - Joseph Firth
- Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
- NICM Health Research InstituteWestern Sydney UniversityWestmeadNew South WalesAustralia
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Libowitz MR, Nurmi EL. The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children. Front Psychiatry 2021; 12:623681. [PMID: 33776816 PMCID: PMC7994286 DOI: 10.3389/fpsyt.2021.623681] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
Antipsychotic medications are critical to child and adolescent psychiatry, from the stabilization of psychotic disorders like schizophrenia, bipolar disorder, and psychotic depression to behavioral treatment of autism spectrum disorder, tic disorders, and pediatric aggression. While effective, these medications carry serious risk of adverse events-most commonly, weight gain and cardiometabolic abnormalities. Negative metabolic consequences affect up to 60% of patients and present a major obstacle to long-term treatment. Since antipsychotics are often chronically prescribed beginning in childhood, cardiometabolic risk accumulates. An increased susceptibility to antipsychotic-induced weight gain (AIWG) has been repeatedly documented in children, particularly rapid weight gain. Associated cardiometabolic abnormalities include central obesity, insulin resistance, dyslipidemia, and systemic inflammation. Lifestyle interventions and medications such as metformin have been proposed to reduce risk but remain limited in efficacy. Furthermore, antipsychotic medications touted to be weight-neutral in adults can cause substantial weight gain in children. A better understanding of the biological underpinnings of AIWG could inform targeted and potentially more fruitful treatments; however, little is known about the underlying mechanism. As yet, modest genetic studies have nominated a few risk genes that explain only a small percentage of the risk. Recent investigations have begun to explore novel potential mechanisms of AIWG, including a role for gut microbiota and microbial metabolites. This article reviews the problem of AIWG and AP metabolic side effects in pediatric populations, proposed mechanisms underlying this serious side effect, and strategies to mitigate adverse impact. We suggest future directions for research efforts that may advance the field and lead to improved clinical interventions.
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Affiliation(s)
| | - Erika L. Nurmi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Carney R, Firth J, Pedley R, Law H, Parker S, Lovell K. The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 70:80-97. [PMID: 33773375 PMCID: PMC8135692 DOI: 10.1016/j.genhosppsych.2021.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Serious mental illness is associated with physical health comorbidities, however most research has focused on adults. We aimed to synthesise existing literature on clinical and behavioral cardiometabolic risk factors of young people on mental health inpatient units. METHODS A systematic review and meta-analysis was conducted, using electronic searches of PsycINFO, EMBASE, AMED, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE. Eligible studies included child/adolescent mental health inpatient units for <25 years, reporting clinical/behavioral cardiometabolic risk factors. Studies containing adult samples, case-studies, or eating disorder populations were excluded. The main clinical outcome was weight, and main behavioral outcome was tobacco use. RESULTS Thirty-nine studies were identified (n = 809,185). Pooled prevalence rates of young people who were overweight (BMI > 25) was 32.4% (95% CI 26.1%-39.5%; n = 2789), and who were obese (BMI > 30) was 15.5% (95% CI 4.5%-41.6%; n = 2612). Pooled prevalence rates for tobacco use was 51.5% (95% CI 32.2-70.2; N = 804,018). Early signs of metabolic risk were observed; elevated blood cholesterol, presence of physical health conditions, and behavioral risk factors (e.g. physical inactivity). CONCLUSIONS This review highlights the vulnerability of young people admitted to inpatient units and emphasises the opportunity to efficiently monitor, treat and intervene to target physical and mental health.
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Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK,NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Heather Law
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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The Relative Risk of Developing Type 2 Diabetes Mellitus in Young Adults with Schizophrenia Treated with Different Atypical Antipsychotic. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2020. [DOI: 10.2478/rjdnmd-2019-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aim: While the link between antipsychotic treatment and metabolic adverse events, including type 2 diabetes mellitus (T2DM) are clear in adults with schizophrenia, in young this association is not so well studied although the use of secondgeneration antipsychotics (SGA) is more and more frequent.
Material and methods: The local diabetes register was compared with the list of all registered young adults (18-35 years) with schizophrenia 2 years retrospective and 2 years prospective. Cumulative incidence, rate of incidence and relative risk was calculated knowing the number of persons in this age group within this region.
Results: Cumulative incidence for exposed group was 0.7% with a rate of incidence of 6.27 (95%CI: 4.1-10.5) per 1,000 patientyears, when in normal population was 0.2%, respectively 2.01 (95%CI: 0.72-3.79). This means a relative risk of 3.4736 (95%CI: 1.79-6.72), p=0.0002 and NNH=202 (95%CI: 134-404). Multivariate analysis showed that gender male (OR=1.83; 95%CI: 0.9-2.7; p=0.002) and olanzapine prescription (OR=4.76; 95%CI: 1.7-7.7; p=0.0001) were independent risk factors for T2DM.
Conclusions: The metabolic risk should be taken in account every time introducing or changing a SGA in young schizophrenic patient, balancing the benefits and negative metabolic effects (especially with olanzapine). Healthy nutrition and physical activities are necessary components of these patients lifestyle to avoid early onset of T2DM.
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The effects of antipsychotic medications on microbiome and weight gain in children and adolescents. BMC Med 2019; 17:112. [PMID: 31215494 PMCID: PMC6582584 DOI: 10.1186/s12916-019-1346-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have unwanted side effects, such as weight gain, potentially further increasing risk for morbidities including obesity, diabetes, and cardiovascular disease. While various mechanisms for this weight gain have been proposed, including effects on metabolic hormone signaling, recent evidence points to the importance of the gut microbiome in this process. The microbial communities residing within the gut are affected by second-generation antipsychotics and can confer weight gain. MAIN TEXT This review summarizes recent findings and presents data linking second-generation antipsychotics, gut microbiota alterations and weight gain. The review focuses on children and adolescent populations, which have not previously received much attention, but are of great interest because they may be most vulnerable to gut microbiome changes and may carry long-term metabolic effects into adulthood. CONCLUSIONS We present correlations between second-generation antipsychotics, gut microbiota alterations and weight gain, and suggest some mechanisms that may link them. A better understanding of the underlying mechanisms may lead to the design of improved treatments for psychotic disorders with fewer harmful side effects.
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Ncube KR, Khamker N, van der Westhuizen D, Corbett T. A descriptive study of biological and psychosocial factors associated with body mass index for age, in adolescents attending an outpatient department at Weskoppies Psychiatric Hospital. S Afr J Psychiatr 2018; 23:973. [PMID: 30263176 PMCID: PMC6138078 DOI: 10.4102/sajpsychiatry.v23i0.973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/04/2017] [Indexed: 01/18/2023] Open
Abstract
Objective To describe biological and psychosocial factors associated with body mass index (BMI) for age in adolescents attending an outpatient department at Weskoppies Psychiatric Hospital. Methods A total of 50 adolescents participated in a convenience sampling research study. BMIs were calculated using their weights and heights to distinguish different weight categories based on the 2007 World Health Organization (WHO) growth charts. Based on their BMIs, participants were categorised as underweight, normal body weight, overweight and obese. The association between the BMIs of the biological parents and their adolescent children was investigated using the Fisher's exact test. The data collection included adolescents' demographic information, psychiatric diagnosis, psychiatric medication, nutritional intake, eating habits and the intensity of physical activity such as sports, leisure and sedentary behaviour. Setting The study was conducted at Weskoppies Psychiatric Hospital's adolescents outpatient department. Results Of the participants, 72% were males. Forty-eight per cent of all the adolescents had a normal BMI, mostly of black African descent. When comparing the adolescents' BMI with that of their biological mothers, 50% of those who were obese also had mothers who were mostly obese (53.8%). The Fisher's exact test indicated a statistically significant association between the BMI categories of mothers and those of their adolescent children (Fisher's exact test, p = 0.032). Despite the above association, no significant association could be found regarding their nutritional intake and eating habits. Also, no significant association was found between the adolescents' BMIs and the use of psychotropic medication, as compared with other previous studies. Furthermore, no association could be found between adolescents' BMI categories and the level of intensity of physical activity such as sports and leisure activities or sedentary behaviours. Conclusion This study supports previous findings that a significant association exists between maternal and childhood obesity. The association between BMI and psychotropic medication, nutritional intake and eating habits, and level of physical activity could not be confirmed in our study. The study results were limited by the small sample size and the convenience sampling method. Although this was only a descriptive study, it highlighted the complexity of biological and psychosocial factors involved in weight gain. Further studies are needed to explore the interplay of physical and environmental risk factors for childhood obesity, as well as to ensure early identification and education of patients and their families to prevent development of obesity.
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Affiliation(s)
- Kgomotso R Ncube
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, University of Pretoria
| | - Nadira Khamker
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, University of Pretoria
| | | | - Thea Corbett
- Department of Statistics, University of Pretoria, South Africa
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Chee GL, Wynaden D, Heslop K. The provision of physical health care by nurses to young people with first episode psychosis: A cross-sectional study. J Psychiatr Ment Health Nurs 2018; 25:411-422. [PMID: 29904970 DOI: 10.1111/jpm.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: This paper addresses an identified gap in the international literatures related to physical health care of young people with first episode psychosis. Previous studies indicate that nurses' skills, knowledge and attitudes influence physical health outcomes for service users. The educational preparation of nurses influences their physical health care nursing practices. Nurses who have a high level of skills, knowledge and positive attitudes towards the provision of physical health care are more likely to initiate this care to young people experiencing first episode psychosis Young people experiencing first episode psychosis are more likely to have physical health comorbidities and less likely to receive treatment for them than young people in the general population. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: Psychiatric/mental health educated nurses are more likely to provide routine physical health care, for example checking that service users have a general practitioner for health care follow-ups, while comprehensive/generalist educated nurses also consider the young person's more complex physical health care needs such as smoking cessation and sexual health. The length of nurses' employment in mental health did not have any significant influence on their physical health care practices to young people. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses working in the mental health setting provide physical health care to young people experiencing first episode psychosis, so it is important to determine if their educational preparation affects their physical health care practices. Provision of professional education opportunities and resources will enable nurses to improve their knowledge, skills and increase their awareness of the importance of providing comprehensive physical health care to young people experiencing first episode psychosis. Education providers need to emphasize the importance of providing physical health care to young people as part of mental health content in undergraduate nursing curricula. ABSTRACT Background Registered nurses working in the area of mental health complete either a psychiatric/mental health or comprehensive/generalist nursing program, and their education preparation influences their physical health care nursing practices. The differences in educational preparation may be a contributory factor to nurses' delivery of physical health care to young people experiencing first episode psychosis. This paper addresses an identified gap in nursing practices related to physical health care of young mental health service users. Aim To examine the relationship between the educational preparation of nurses and attitudes, confidence level, perceived barriers and physical health care nursing practices. Method A cross-sectional survey was conducted in 2015 with 207 nurses using the modified Physical Health Attitude Scale for Mental Health Nurses (PHASe). Results Comprehensive/generalist prepared nurses were more likely to provide education on heart disease prevention and sexual health and support young people to stop cigarette smoking than psychiatric/mental health nurses. However, as the length of service progresses, the propensity for psychiatric/mental health nurses to be involve in smoking cessation increases. Implication for practice It is important to identify how nurses' educational preparation affects their nursing practices so as to address the gaps in their physical health literacy.
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Affiliation(s)
- Gin-Liang Chee
- Community Mental Health Nursing, South Metropolitan Health Service, Perth, WA, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
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Shapiro M, Reid A, Olsen B, Taasan M, McNamara J, Nguyen M. Topiramate, zonisamide and weight loss in children and adolescents prescribed psychiatric medications: A medical record review. Int J Psychiatry Med 2017; 51:56-68. [PMID: 26681236 DOI: 10.1177/0091217415621266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Childhood obesity is a growing epidemic that is contributed to by the use of psychopharmacological agents, such as antipsychotics. This study represents a preliminary investigation into the effectiveness of two anticonvulsants that were hypothesized to reduce weight in a pediatric sample seeking treatment at a psychiatric clinic. METHODS The electronic medical records of a university-based child and adolescent psychiatric clinic were reviewed for patients who were first prescribed either topiramate or zonisamide between 1 July 2011 and 30 June 2013. Based on inclusionary criteria, the review identified 47 children or adolescents. RESULTS Multilevel modeling was utilized for study analyses. Including the full sample and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 1.3 (dosages above 200 mg) to 4.1 (dosages below 50 mg) every six months of treatment. Exlucing patients whose baseline body mass index was below 25.0 and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 3.2 (dosages above 200 mg) to 6.1 (dosages below 50 mg) every six months of treatment. Weight reduction was not statistically different between topiramate or zonisamide. Anticonvulsants were associated with an increase in body mass index, yet the benefits of the two anticonvulsants on weight loss remained despite the counteractive effects of antipsychotics. CONCLUSIONS Results provide preliminary evidence that topiramate and zonisamide may be utilized for weight loss in a pediatric psychopharmacological treatment seeking sample, even if antipsychotics are also prescribed. A randomized controlled trial investigating the impact of topiramate and zonisamide on weight reduction is warranted.
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Affiliation(s)
- Michael Shapiro
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Adam Reid
- Division of Medical Psychology, Department of Psychiatry, University of Florida, Gainesville, FL, USA Division of Clinical & Health Psychology, Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Brian Olsen
- Division of Medical Psychology, Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Michael Taasan
- Division of Medical Psychology, Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Joseph McNamara
- Division of Medical Psychology, Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Mathew Nguyen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida, Gainesville, FL, USA
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Dayabandara M, Hanwella R, Ratnatunga S, Seneviratne S, Suraweera C, de Silva VA. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat 2017; 13:2231-2241. [PMID: 28883731 PMCID: PMC5574691 DOI: 10.2147/ndt.s113099] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other confounders such as lifestyle, genetic and illness factors make interpretation of data difficult.
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Affiliation(s)
| | - Raveen Hanwella
- Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Suhashini Ratnatunga
- Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sudarshi Seneviratne
- Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chathurie Suraweera
- Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Varuni A de Silva
- Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Happell B, Galletly C, Castle D, Platania-Phung C, Stanton R, Scott D, McKenna B, Millar F, Liu D, Browne M, Furness T. Scoping review of research in Australia on the co-occurrence of physical and serious mental illness and integrated care. Int J Ment Health Nurs 2015. [PMID: 26220151 DOI: 10.1111/inm.12142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The physical health of people with serious mental illness (SMI) has become a focal area of research. The aim of the present study was to ascertain the attention and distribution of research from within Australia on physical illness and SMI co-occurrence, and to identify gaps. A scoping review of peer-reviewed research literature from Australia, published between January 2000 and March 2014, was undertaken through an electronic literature search and coding of papers to chart trends. Four trends are highlighted: (i) an almost threefold increase in publications per year from 2000-2006 to 2007-2013; (ii) a steady release of literature reviews, especially from 2010; (iii) health-related behaviours, smoking, integrated-care programmes, and antipsychotic side-effects as the most common topics presented; and (iv) paucity of randomized, controlled trials on integrated-care models. Despite a marked increase in research attention to poorer physical health, there remains a large gap between research and the scale of the problem previously identified. More papers were descriptive or reviews, rather than evaluations of interventions. To foster more research, 12 research gaps are outlined. Addressing these gaps will facilitate the reduction of inequalities in physical health for people with SMI. Mental health nurses are well placed to lead multidisciplinary, consumer-informed research in this area.
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Affiliation(s)
- Brenda Happell
- Synergy, Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra Hospital, ACT, Canberra, Australia
| | - Cherrie Galletly
- The Adelaide Clinic, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - David Castle
- St Vincent's Hospital, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Chris Platania-Phung
- Synergy, Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra Hospital, ACT, Canberra, Australia
| | - Robert Stanton
- Central Queensland University, Central Queensland University, School of Human Health and Social Sciences, Bundaberg, Queensland, Australia
| | - David Scott
- Central Queensland University, School of Medical and Applied Sciences, Melbourne, Victoria, Australia
| | - Brian McKenna
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne, Victoria, Australia
| | | | - Dennis Liu
- Northern Mental Health Service, Salisbury, South Australia, Australia
| | - Matthew Browne
- Central Queensland University, Central Queensland University, School of Human Health and Social Sciences, Bundaberg, Queensland, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne, Victoria, Australia
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Nielsen RE, Laursen MF, Vernal DL, Bisgaard C, Jakobsen H, Steinhausen HC, Correll CU. Risk of diabetes in children and adolescents exposed to antipsychotics: a nationwide 12-year case-control study. J Am Acad Child Adolesc Psychiatry 2014; 53:971-979.e6. [PMID: 25151420 DOI: 10.1016/j.jaac.2014.04.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 03/27/2014] [Accepted: 05/19/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Antipsychotics are associated with weight gain and diabetes. The risk and rate of diabetes in children and adolescents treated with antipsychotics is unclear. METHOD A longitudinal register linkage case-control study of diabetes in all psychiatric patients aged <18 years in Denmark was performed from January 1999 through the end of June 2010. Patients with and without antipsychotic exposure were compared regarding the occurrence of type 2 diabetes, defined as the prescription of oral antidiabetic medication. Regression analyses with type 2 diabetes as the dependent variable were conducted with sex, age, and diagnoses as covariates. RESULTS We compared the risk of diabetes in 48,299 psychiatrically ill youth. Of 7,253 youth exposed to antipsychotics, 52 (0.72%; 95% CI = 0.52% - 0.91%) developed type 2 diabetes. Of 41,046 youth without exposure to antipsychotics, 111 (0.27%; 95% CI = 0.22% - 0.32%) developed type 2 diabetes. In a 25,033 + 16,013 logistic regression analysis, type 2 diabetes development was associated with antipsychotic drug exposure (odds ratio [OR] = 1.60; 95% CI = 1.08 - 2.36, p < .05) female sex, (OR = 4.48; 95% CI = 2.90 - 6.91, p < 0.001) and older age at first psychiatric diagnosis (OR = 1.19; 95% CI = 1.12 - 1.27, p < 0.001), but not with psychiatric diagnosis. In a Cox-regression analysis, shorter time to type 2 diabetes onset was associated with female sex (Hazard Ratio (HR) = 4.83; 95% CI = 3.05-7.66, p = 0.001), and older age at first psychiatric diagnosis (HR = 1.19; 95% CI = 1.12-1.28, p = 0.001), while antipsychotic exposure (HR) = 1.41; 95% CI = 0.92-2.16, p = 0.11) trended towards increasing the rate of diabetes. CONCLUSION Antipsychotic treatment, female sex, and older age at psychiatric diagnosis were associated with a significantly more frequent type 2 diabetes onset in children and adolescents. Strict indications for antipsychotic treatment and routine cardiometabolic monitoring are crucial.
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Affiliation(s)
| | | | | | | | | | | | - Christoph U Correll
- Zucker Hillside Hospital, North Shore Long Island Jewish Health System, Glen Oaks, NY and Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY
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Weight gain and increase of body mass index among children and adolescents treated with antipsychotics: a critical review. Eur Child Adolesc Psychiatry 2013; 22:457-79. [PMID: 23503976 DOI: 10.1007/s00787-013-0399-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/28/2013] [Indexed: 01/30/2023]
Abstract
We performed an updated review of the available literature on weight gain and increase of body mass index (BMI) among children and adolescents treated with antipsychotic medications. A PubMed search was conducted specifying the following MeSH terms: (antipsychotic agents) hedged with (weight gain) or (body mass index). We selected 127 reports, including 71 intervention trials, 42 observational studies and 14 literature reviews. Second-generation antipsychotics (SGAs), in comparison with first-generation antipsychotics, are associated with a greater risk for antipsychotic-induced weight gain although this oversimplification should be clarified by distinguishing across different antipsychotic drugs. Among SGAs, olanzapine appears to cause the most significant weight gain, while ziprasidone seems to cause the least. Antipsychotic-induced BMI increase appears to remain regardless of the specific psychotropic co-treatment. Children and adolescents seem to be at a greater risk than adults for antipsychotic-induced weight gain; and the younger the child, the higher the risk. Genetic or environmental factors related to antipsychotic-induced weight gain among children and adolescents are mostly unknown, although certain genetic factors related to serotonin receptors or hormones such as leptin, adiponectin or melanocortin may be involved. Strategies to reduce this antipsychotic side effect include switching to another antipsychotic drug, lowering the dosage or initiating treatment with metformin or topiramate, as well as non-pharmacological interventions. Future research should avoid some methodological limitations such as not accounting for age- and sex-adjusted BMI (zBMI), small sample size, short period of treatment, great heterogeneity of diagnoses and confounding by indication.
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Eapen V, Shiers D, Curtis J. Bridging the gap from evidence to policy and practice: reducing the progression to metabolic syndrome for children and adolescents on antipsychotic medication. Aust N Z J Psychiatry 2013; 47:435-42. [PMID: 23047958 DOI: 10.1177/0004867412463169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES For children and adolescents, the adverse effects from antipsychotic medicines exaggerate the already considerable burden of having a serious mental illness. Many of these young people face a future not only limited by stigmatizing psychiatric illness but also a life restricted and shortened by physical ill-health, particularly cardiovascular disease and type-2 diabetes. This review focuses on bridging the current gap between available evidence and practice guidelines and policies. METHOD Following an extensive literature search, key papers focusing on the evidence of the nature and occurrence of metabolic morbidity in children and adolescents following the use of antipsychotic medication were included. RESULTS There is growing evidence to suggest that some of the key antecedents of metabolic syndrome occur soon after diagnosis and initiation of antipsychotic medication, and they accumulate over time. CONCLUSION While guidelines and policies around the monitoring of metabolic syndrome in children and adolescents with mental illness receiving antipsychotic medication are limited, an opportunity lies in altering the trajectory towards cardiovascular disease and type-2 diabetes by early recognition and intervention to reduce cardiometabolic risk rather than waiting until disease end-points are reached later in life.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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Walter G, Robertson M, Soh N. Milestones for a college and journal. Australas Psychiatry 2013; 21:5-7. [PMID: 23344799 DOI: 10.1177/1039856212472379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Centorrino F, Masters GA, Talamo A, Baldessarini RJ, Öngür D. Metabolic syndrome in psychiatrically hospitalized patients treated with antipsychotics and other psychotropics. Hum Psychopharmacol 2012; 27:521-6. [PMID: 22996619 DOI: 10.1002/hup.2257] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We evaluated prevalence and risk factors for metabolic syndrome in inpatients treated with antipsychotics, with or without other psychotropic drugs. Although the literature on metabolic syndrome in psychiatry has expanded in recent years, we seek to elucidate some of the remaining gaps by examining a severely and chronically ill population heavily treated with pharmacological agents. METHODS With data from medical records of 589 adults hospitalized at McLean Hospital in 2010 and 2011, we used standard statistical analyses to characterize risks and covariates of metabolic syndrome. RESULTS With prior antipsychotic treatment, prevalence of metabolic syndrome was 29.5%. The syndrome was strongly associated with being overweight (≥25 kg/m(2) in 60.1% of subjects), older age, longer treatment-exposure, schizoaffective diagnosis (39.8%), more illness-episodes or hospitalizations, polytherapy, and higher total daily chlorpromazine-equivalent doses, but not sex. Notably, metabolic syndrome risk was greater among young, antipsychotic treated patients (15.5-fold at age ≤25 years). CONCLUSIONS The findings extend information on the association of metabolic syndrome with antipsychotic treatment. Metabolic syndrome was found in 30% of antipsychotic-exposed inpatients. Risk was surprisingly high in young persons and after brief treatment-exposure, and psychotropic polytherapy increased risk.
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Affiliation(s)
- Franca Centorrino
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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