Study Looks at Cardiometabolic Risk, Schizophrenia and Antipsychotic Treatment


Bottom Line: The duration of psychiatric illness and treatment for patients after first-episode schizophrenia spectrum disorders (FES) appears to be associated with being fatter and having other cardiometabolic abnormalities.

Authors: Christoph U. Correll, M.D., of the North Shore-LIJ Health System, the Zucker Hillside Hospital, Glen Oaks, N.Y., and colleagues.

Background:  FES is associated with higher death rates and the vast majority of premature deaths in this group are related to cardiovascular illness and obesity-related cancers. Patients with FES require attention for both psychiatric and medical health.

How the Study Was Conducted: The authors analyzed baseline results from a study of patients after an initial schizophrenia episode. Data was collected from 34 community mental health centers from July 2010 to July 2012. The patients (average age nearly 24 years) had a confirmed FES diagnosis and had less than six months of lifetime antipsychotic treatment.

Results: Of the 394 of 404 patients with available cardiometabolic data, 48.3 percent were obese or overweight, 50.8 percent smoked, 56.5 percent had abnormal cholesterol (dyslipidemia, only 0.5 percent received lipid-lowering medications), 39.9 percent had prehypertension, 10 percent had hypertension (only 3.6 percent received antihypertensive medication) and 13.2 percent had metabolic syndrome. Higher body mass index, fat mass, fat percentage and waist circumference were associated with the total duration of psychiatric illness. The duration of antipsychotic treatment was correlated with higher non-HDL-C triglycerides and triglycerides-to-HDL-C ratio, as well as lower HDL-C and systolic blood pressure. The antipsychotic medication olanzapine was associated with higher triglycerides, insulin and insulin resistance, and quetiapine fumarate was associated with higher triglycerides to HDL-C ratio.

Discussion: “Further research is needed to assess the trajectory of cardiometabolic risk, underlying mechanisms and mediating variables, including preferred treatment choices for FES and/or cardiometabolic risk factors.'

(JAMA Psychiatry. Published online October 8, 2014. doi:10.1001/jamapsychiatry.2014.1314