Metabolic Syndrome in First Episode Schizophrenia, Based on the National Mental Health Registry of Schizophrenia (NMHR) in a General Hospital in Malaysia: A 10-Year Retrospective Cohort Study

Global Prevalence of Metabolic Syndrome in Schizophrenia Patients: A Systematic Review and Meta-Analysis

The prevalence of metabolic syndrome in patients with schizophrenia has significantly increased and can be associated with severe complications such as chronic diseases and mortality. Despite numerous studies, a comprehensive estimate of the prevalence of metabolic syndrome in schizophrenia patients is lacking. Therefore, this study aimed to estimate the global prevalence of metabolic syndrome in schizophrenia patients through a systematic review and meta-analysis. This study was conducted as a systematic review and meta-analysis based on PRISMA guidelines without time restrictions until April 1, 2024. Relevant articles were identified through searches in databases including Scopus, Web of Science (WoS), PubMed, Science Direct, Embase, and Google Scholar, using key terms combined with AND & OR operators. After removing duplicates and conducting primary and secondary screening, 12 studies were included in the meta-analysis. Data were analysed using the random-effects model in Comprehensive Meta-Analysis Version 2 software. This analysis included 12 studies with 1,953 participants. The pooled prevalence of metabolic syndrome was 41.3% (95% CI: 28.8-55.1), with significant heterogeneity (I2: 96.3%). The highest prevalence was reported in France (79.1%) and the lowest in China (18.03%). Over one-third of patients with schizophrenia are affected by metabolic syndrome. Hence, greater attention should be paid to the prevention and reduction of complications and mortality associated with metabolic syndrome in schizophrenia patients.

Risk factors for metabolic syndrome in individuals with recent-onset psychosis at disease onset and after 1-year follow-up

Metabolic syndrome (MetS) is a cluster of parameters encompassing the most dangerous heart attack risk factors, associated with increased morbidity and mortality. It is highly prevalent in recent-onset psychosis (ROP) patients. In this pilot study, we evaluated MetS parameters (fasting glucose, high-density lipoprotein (HDL) cholesterol (HDL-c), fasting triglycerides, waist circumference, and systolic and diastolic blood pressure), clinical symptoms, pharmacological treatment, lifestyle, and inflammatory markers in 69 patients with ROP and 61 healthy controls (HCs). At baseline, waist circumference (p = 0.005) and fasting triglycerides (p = 0.007) were higher in patients with ROP than in HCs. At the 1-year follow-up, patients showed clinical improvement, with a reduction in the positive and negative syndrome scale (PANSS) score (p < 0.001), dietary intake (p = 0.001), and antipsychotic medication dose (p < 0.001); however, fasting glucose (p = 0.011), HDL-c (p = 0.013) and waist circumference worsened (p < 0.001). We identified sex, age, BMI, dietary intake, physical activity, daily tobacco use, daily cannabis use, and antipsychotic doses as risk factors contributing to baseline MetS parameters. After 1-year follow-up, those factors plus the PANSS and Calgary Depression Scale for Schizophrenia (CDSS) scores were associated with MetS parameters. Further studies are needed to understand the contributions of the studied risk factors in patients with ROP at onset and during disease progression.

The Predictive Role of Aberrant Metabolic Parameters and Negative Automatic Thinking on the Cognitive Impairments Among Schizophrenia Patients with Metabolic Syndrome

PURPOSE

The study aimed to clarify the cognitive impairments of schizophrenia with metabolic syndrome while evaluating their potential as risk factors.

PATIENTS AND METHODS

We recruited 153 participants and divided them into three groups according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria and the guideline standards for the prevention and treatment of dyslipidemia in Chinese adults in 2007 for metabolic syndrome, as follows: healthy control group (n = 47); nonmetabolic syndrome group (n = 58); and metabolic syndrome group (n = 48). Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale. Cognitive function and automatic thinking were estimated using the Montreal Cognitive Assessment Scale, Verbal Fluency Test, and Automatic Thoughts Questionnaire. Serum biochemical parameters were measured by automatic biochemistry analyzer.

RESULTS

One-way ANOVA analysis revealed that differential cognition impairments in schizophrenia patients compared to controls. Furthermore, results of multiple comparisons showed that more serious barriers in orientation, language fluency, and negative automatic thinking existed in the metabolic syndrome group than in the healthy and non-metabolic syndrome groups. Spearman correlation and stepwise linear regression analyses showed that psychopathological symptoms, high waist circumference, and high triglyceride were the predictive factors for negative automatic thoughts, orientation, and language fluency. Those results collectively revealed that high waist circumference, high triglyceride and negative automatic thinking had validity and effectiveness in predicting the cognitive function impairments of the metabolic syndrome group.

CONCLUSION

The present findings strongly supported the notion that aberrant parameters of high waist circumference, high triglyceride and high negative automatic thoughts had validity and effectiveness predictive role for cognitive impairments in the schizophrenics with metabolic syndrome. The schizophrenia patients with metabolic syndrome should receive regular monitoring and adequate treatment for metabolic and psychological risk factors.

The prevalence and clinical correlates of metabolic syndrome and cardiometabolic alterations in 430 drug-naive patients in their first episode of schizophrenia

RATIONALE

Although metabolic abnormalities and metabolic syndrome (MetS) have been extensively investigated in schizophrenia, few studies have examined them in first-episode drug-naive (FEDN) patients.

OBJECTIVES

This study aimed to investigate the prevalence and clinical correlates of metabolic abnormalities in FEDN schizophrenia patients.

METHODS

A total of 430 FEDN schizophrenia patients and 453 controls were recruited. Various parameters were measured including BMI, waist circumference, blood pressure, lipid profiles, blood glucose, glycosylated hemoglobin (HbA1c), insulin, and homeostatic model assessment for insulin resistance (HOMA-IR).

RESULTS

Patients had a higher prevalence of MetS, hypertension, hypertriglyceridemia, hypo-HDL-C, elevated HAb1c, and elevated insulin than controls (19.1% vs. 6.6%, OR = 2.52; 33.3% vs. 12.1%, OR = 3.05; 30.5% vs. 16.1%, OR = 2.25; 43.1% vs. 24.0%, OR = 2.21; 25.6% vs. 10.8%, OR = 2.62; 9.1% vs. 0.9%, OR = 10.29; all p_Bonferroni < 0.001). Waist circumference was associated with PANSS general psychopathology and total score (correlation coefficient r = 0.17, p_Bonferroni < 0.001; correlation coefficient r = 0.16, p_Bonferroni = 0.004). Fasting glucose was associated with PANSS negative, general psychopathology, and total score (correlation coefficient r = 0.13, p_Bonferroni = 0.03; correlation coefficient r = 0.19, p_Bonferroni < 0.001; correlation coefficient r = 0.20, p_Bonferroni < 0.001). BMI (OR = 1.37), smoking (OR = 3.39), and HOMA-IR (OR = 5.60) were associated with MetS in FEDN schizophrenia (all p < 0.001).

CONCLUSIONS

Our results demonstrate that MetS and metabolic abnormalities co-existed in the early stages of schizophrenia without antipsychotics. Waist circumference and glucose were associated with psychopathological symptoms, while BMI, smoking, and HOMA-IR were associated with MetS in FEDN schizophrenia.

Smoking Affects the Patterns of Metabolic Disorders and Metabolic Syndrome in Patients With First-Episode Drug-Naive Schizophrenia: A Large Sample Study Based on the Chinese Han Population

OBJECTIVE

Although metabolic disorders and smoking are common in schizophrenia, few studies have investigated the effects of smoking on metabolic disorders or metabolic syndrome (MetS) in schizophrenia patients, especially in first-episode drug-naïve (FEDN) patients. We sought to investigate the differences in metabolic disorders and MetS between smoking and nonsmoking FEDN schizophrenia patients.

METHODS

A total of 428 FEDN schizophrenia patients and 435 controls were recruited. Blood pressure, waist circumference, body mass index (BMI), lipid profiles, and glucose metabolism were measured. The psychopathology was evaluated by Positive and Negative Syndrome Scale.

RESULTS

FEDN schizophrenia patients had a higher smoking rate than controls (23.8% vs 14.0%, P < .001). After adjusting for confounding variables, the prevalence of MetS, overweight, hypertension, hypertriglyceridemia, elevated insulin, and insulin resistance in smoking patients was higher than those in nonsmoking patients, while overweight and hypertension were higher in the smoking controls than in nonsmoking controls (all P < .05). In smoking patients, triglyceridemia, high-density lipoprotein cholesterol, and fasting blood glucose were the main contributing components to MetS, while in nonsmoking patients, waist circumference, systolic blood pressure, triglyceridemia, high-density lipoprotein cholesterol, and fasting blood glucose were the main contributing components to MetS. In smoking patients, BMI and homeostatic model assessment for insulin resistance were associated factors of MetS (both P < .05). In nonsmoking patients, sex, BMI, insulin, and homeostatic model assessment for insulin resistance were associated factors of MetS (all P < .05).

CONCLUSIONS

Our study indicates that smoking schizophrenia patients have a higher prevalence of MetS and metabolic disorders than nonsmoking patients. Moreover, smoking and nonsmoking patients have different contributing components and associated factors for MetS.

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

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

Risk Factors of Metabolic Syndrome Among Patients Receiving Antipsychotics: A Retrospective Study

This study aimed to assess the differential effects of first-generation (FGA) and second-generation antipsychotics (SGA) on the prevalence of risk factors for metabolic syndrome among mentally ill patients in Qatar. We also wanted to check if there is proper adherence with the guidelines for prescribing antipsychotics and the monitoring of metabolic effects in this population. We collected the available retrospective data (socio-demographic, psychiatric, anthropometric, and metabolic measures) from the records of 439 patients maintained on antipsychotics. The majority were males, married, employed, having a psychotic disorder, and receiving SGA. Patients on SGA showed more obesity, higher BP, and more elevated triglycerides compared to those on FGA. The prevalence of the abnormal metabolic measures was high in this sample, but those on SGA showed a significantly higher prevalence of abnormal body mass index and BP. Obesity and hypertension were common in patients maintained on antipsychotics, especially those on SGA. Polypharmacy was common, and many metabolic measures were not monitored properly in those maintained on antipsychotics. More prospective studies with guided monitoring of the patients' clinical status and metabolic changes are needed to serve better this population of patients.

Effect of Atypical Antipsychotic on Blood Pressure in Inpatients with Schizophrenia of Prof. Dr. Soerojo Mental Health Hospital Magelang

Context:

Schizophrenia ranks the top of all mental disorders with poor prognosis. Central Java Province is in the top five of schizophrenia incidents in Indonesia. Antipsychotic is the main therapy for schizophrenia, which is divided into 2, atypical and typical. The atypical antipsychotic is more preferable because of the minimal effect of the extrapyramidal syndrome but affects the blood pressure.

Aims:

To analyze the blood pressure of schizophrenia inpatients during the pre and post-use of atypical antipsychotics in RSJ Prof. Dr. Soerojo Magelang.

Settings and Design:

This study was an observational study with cohort retrospective methods.

Methods and Material:

The research was approved and reviewed by the committee of ethics and law of Prof. Dr. Soerojo Mental Hospital. The inclusion criteria are those diagnosed with schizophrenia based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM IV), aged about 17-55 years old, receiving antipsychotic atypical therapy for at least 3 months.The exclusion criteria are inpatients who also receive antidepressants and antihypertension, have a history of cardiovascular disease and hypertension, and incomplete medical records.

Statistical analysis used:

Wilcoxon, Mann-Whitney, and Kruskal-Wallis test.

Results:

The result of this study most of them were treated using combination risperidone and clozapine (82.1%). In this study, 43 inpatients experienced a decrease in systolic blood pressure, 57 in systolic blood pressure, 6 with no change in systolic blood pressure, 47 a decrease in diastolic blood pressure, 50 an increase in diastolic blood pressure, and 9 with no change in diastolic blood pressure.

Conclusions:

There was no significant difference in the blood pressure before and after the treatment.