Korean J Schizophr Res.  2012 Jun;15(1):39-45. 10.16946/kjsr.2012.15.1.39.

Prevalence of the Metabolic Syndrome among Outpatients with Schizophrenia or Schizoaffective Disorder

• Lee HY
• Choi JE

• KMID: 1790746
• DOI: http://doi.org/10.16946/kjsr.2012.15.1.39

Abstract

OBJECTIVES
The aim of this study were to assess a) the prevalence of metabolic syndrome in outpatients with schizophrenia or schizoaffective disorder, b) the comparison of characteristics of patients with or without the metabolic syndrome, c) the sensitivity, specificity and positive predictive values of individual criteria for metabolic syndrome.
METHODS
This study assessed the prevalence of the metabolic syndrome among 128 schizophrenia or schizoaffective disorder patients using the National Cholesterol Education Program-Adult Treatment Panel III.
RESULTS
Of patients, 54.7% (M : 49.3%, F : 61.4%) had metabolic syndrome. The metabolic syndrome was associated with medical history of diabetes, hypertension and dyslipidemia. Presence of abdominal obesity was most sensitive (97.1%), while raised fasting glucose was most specific (89.7%). Combining abdominal obesity/raised triglycerides and abdominal obesity/low HDL cholesterol had 100% sensitivity.
CONCLUSION
The metabolic syndrome is highly prevalent among outpatients with schizophrenia or schizoaffective disorder. This study suggests that the measurement of abdominal obesity is a simple test to identify individuals at high risk for metabolic syndrome.

Keyword

Schizophrenia; Schizoaffective disorder; Metabolic syndrome; Prevalence

MeSH Terms

Cholesterol
Cholesterol, HDL
Dyslipidemias
Fasting
Glucose
Humans
Hypertension
Obesity, Abdominal
Outpatients
Prevalence
Psychotic Disorders
Schizophrenia
Sensitivity and Specificity
Triglycerides
Cholesterol
Cholesterol, HDL
Glucose
Triglycerides

Reference

1. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002. 288:2709–2716.

2. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998. 15:539–553.

3. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001. 285:2486–2497.

4. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome--a new worldwide definition. Lancet. 2005. 366:1059–1062.

5. Brown S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry. 1997. 171:502–508.

6. Curkendall SM, Mo J, Glasser DB, Rose Stang M, Jones JK. Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada. J Clin Psychiatry. 2004. 65:715–720.

7. Hagg S, Lindblom Y, Mjorndal T, Adolfsson R. High prevalence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia. Int Clin Psychopharmacol. 2006. 21:93–98.

8. Cohn T, Prud'homme D, Streiner D, Kameh H, Remington G. Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. Can J Psychiatry. 2004. 49:753–760.

9. Dixon L, Postrado L, Delahanty J, Fischer PJ, Lehman A. The association of medical comorbidity in schizophrenia with poor physical and mental health. J Nerv Ment Dis. 1999. 187:496–502.

10. De Hert M, Peuskens B, van Winkel R, Kalnicka D, Hanssens L, Van Eyck D, et al. Body weight and self-esteem in patients with schizophrenia evaluated with B-WISE. Schizophr Res. 2006. 88:222–226.

11. Weiden PJ, Mackell JA, McDonnell DD. Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res. 2004. 66:51–57.

12. Newcomer JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005. 19:Suppl 1. 1–93.

13. Wirshing DA. Schizophrenia and obesity: impact of antipsychotic medications. J Clin Psychiatry. 2004. 65:Suppl 18. 13–26.

14. Newcomer JW. Antipsychotic medications: metabolic and cardiovascular risk. J Clin Psychiatry. 2007. 68:Suppl 4. 8–13.

15. Mukherjee S, Schnur DB, Reddy R. Family history of type 2 diabetes in schizophrenic patients. Lancet. 1989. 1:495.

16. Ryan MC, Collins P, Thakore JH. Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. Am J Psychiatry. 2003. 160:284–289.

17. Spelman LM, Walsh PI, Sharifi N, Collins P, Thakore JH. Impaired glucose tolerance in first-episode drug-naive patients with schizophrenia. Diabet Med. 2007. 24:481–485.

18. Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 2008. 371:1085–1097.

19. Scheen AJ, De Hert M. [Drug-induced diabetes mellitus: the exemple of atypical antipsychotics]. Rev Med Liege. 2005. 60:455–460.

20. Scheen AJ, De Hert MA. Abnormal glucose metabolism in patients treated with antipsychotics. Diabetes Metab. 2007. 33:169–175.

21. McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res. 2005. 80:19–32.

22. Nam YY, Kim CS, Ahn CW, Park KM, Ryu B, Kim CH. Clinical Correlates of Metabolic Syndrome in Patients with Chronic Schizophrenia. Korean J Psychopharmacol. 2006. 17:335–341.

23. Jeong JT, Yoon BH, Kim TU, Sea YH, Park SH, Jeong KY, et al. Prevalence of Metabolic Syndrome in Chronic Schizophrenic Inpatients. Korean J Schizophr Res. 2009. 12:83–89.

24. Roh J, Cho YS, Cho AH. The Prevalence of Metabolic Syndrome in Inpatients with Schizophrenia. Korean J Biol Psychiatry. 2011. 18:46–54.

25. Lee NY, Kim SK, Kim SH, Kang U, Kim YS, Ahn YM. Metabolic syndrome in patients with Schizophrenia and Bipolar disorder: comparision with general population. Abstracted presented at the Korea Neuropsychiatric Association Annual Meeting Seoul. 2008.

26. Sugawara N, Yasui-Furukori N, Sato Y, Kishida I, Yamashita H, Saito M, et al. Comparison of prevalence of metabolic syndrome in hospital and community-based Japanese patients with schizophrenia. Ann Gen Psychiatry. 2011. 10:21–29.

27. Association AP. Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-TR). 4th evidence-based text revision ed. 2000. Washington, DC: American Psychiatric Association.

28. Hales RE, Yudofsky SC, Gabbard GO. Text book of Psychiatry. 2008. 5 ed. American psychiatric publishing, Inc..

29. Panz VR, Raal FJ, Paiker J, Immelman R, Miles H. Performance of the CardioChek PA and Cholestech LDX point-of-care analysers compared to clinical diagnostic laboratory methods for the measurement of lipids. Cardiovasc J S Afr. 2005. 16:112–117.

30. World health organization. The Asia-Pacific perspective: redefining obesity and its treatment. 2000. 02. Health Communications, Australia PTY Ltd.

31. Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Schizophrenia and Related Disorders--A Systematic Review and Meta-Analysis. Schizophr Bull. 2011. 12. 29. [Epub ahead of print].

32. Straker D, Correll CU, Kramer-Ginsberg E, Abdulhamid N, Koshy F, Rubens E, et al. Cost-effective screening for the metabolic syndrome in patients treated with second-generation antipsychotic medications. Am J Psychiatry. 2005. 162:1217–1221.

33. Koponen HJ, Hakko HH, Saari KM, Lindeman SM, Karvonen KM, Isohanni MK, et al. The prevalence and predictive value of individual criteria for metabolic syndrome in schizophrenia: a Northern Finland 1966 Birth Cohort Study. World J Biol Psychiatry. 2010. 11:262–267.

34. Kagal UA, Torgal SS, Patil NM, Malleshappa A. Prevalence of the Metabolic Syndrome in Schizophrenic Patients Receiving Second-Generation Antipsychotic Agents--A Cross-Sectional Study. J Pharm Pract. 2012. 05. 02. [Epub ahead of print].

35. Larsen JT, Fagerquist M, Holdrup M, Christensen B, Sigalin C, Nilsson PM. Metabolic syndrome and psychiatrists' choice of follow-up interventions in patients treated with atypical antipsychotics in Denmark and Sweden. Nord J Psychiatry. 2011. 65:40–46.

36. Nasrallah HA, Meyer JM, Goff DC, McEvoy JP, Davis SM, Stroup TS, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res. 2006. 86:15–22.

37. Bobes J, Arango C, Garcia-Garcia M, Rejas J. Healthy lifestyle habits and 10-year cardiovascular risk in schizophrenia spectrum disorders: an analysis of the impact of smoking tobacco in the CLAMORS schizophrenia cohort. Schizophr Res. 2010. 119:101–109.

38. Atmaca M, Kuloglu M, Tezcan E, Ustundag B. Serum leptin and triglyceride levels in patients on treatment with atypical antipsychotics. J Clin Psychiatry. 2003. 64:598–604.

39. Pramyothin P, Khaodhiar L. Metabolic syndrome with the atypical antipsychotics. Curr Opin Endocrinol Diabetes Obes. 2010. 17:460–466.

40. De Hert MA, van Winkel R, Van Eyck D, Hanssens L, Wampers M, Scheen A, et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res. 2006. 83:87–93.

41. Krane-Gartiser K, Breum L, Glumrr C, Linneberg A, Madsen M, Koster A, et al. Prevalence of the metabolic syndrome in Danish psychiatric outpatients treated with antipsychotics. Nord J Psychiatry. 2011. 65:345–352.

42. De Hert M, van Winkel R, Van Eyck D, Hanssens L, Wampers M, Scheen A, et al. Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study. Clin Pract Epidemiol Ment Health. 2006. 2:14–23.

43. Arango C, Bobes J, Aranda P, Carmena R, Garcia-Garcia M, Rejas J. A comparison of schizophrenia outpatients treated with antipsychotics with and without metabolic syndrome: findings from the CLAMORS study. Schizophr Res. 2008. 104:1–12.

44. Schorr SG, Slooff CJ, Bruggeman R, Taxis K. The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year. J Psychiatr Res. 2009. 43:1106–1111.

45. Medved V, Kuzman MR, Jovanovic N, Grubisin J, Kuzman T. Metabolic syndrome in female patients with schizophrenia treated with second generation antipsychotics: a 3-month follow-up. J Psychopharmacol. 2009. 23:915–922.