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Original article / Araştırma
Comparison of the prevalence of metabolic syndrome in patients with schizophrenia and bipolar disorder: a cross-sectional study from Black Sea region Pınar KIZILAY ÇANKAYA,1 Ahmet TİRYAKİ,2 Filiz CİVİL ARSLAN,3 Sertaç ÇANKAYA4
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ABSTRACT
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Objective: Previous research has suggested that metabolic syndrome is more prevalent among patients with schizophrenia and bipolar disorder. Given the scarcity of comparative research on these disorders, this study aims to compare the prevalence of metabolic syndrome in two diagnostic groups and to identify sociodemographic or clinical factors related to metabolic syndrome. Methods: A total of 235 patients diagnosed with schizophrenia (n=160) and bipolar disorder (n=75) and were being followed up by a metabolic monitoring program in a specialized outpatient clinic and using antipsychotic therapy for at least eight weeks have participated in this cross-sectional study. Patients were diagnosed with metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) criteria. Sociodemographic and clinical data including metabolic records were collected retrospectively by reviewing the patients’ medical records. Results: The overall prevalence of metabolic syndrome was 32.3% and waist circumference was the most frequent individual component with a prevalence of 60%. There were no differences in the prevalence of metabolic syndrome between schizophrenia and bipolar patients. Age, body mass index (BMI), and use of certain types of atypical antipsychotics were found related to metabolic syndrome. Conclusion: The prevalence of metabolic syndrome and its components among patients with severe mental illness is alarming irrespective of their diagnoses. Thus, metabolic screening is crucial especially for high-risk groups. (Anatolian Journal of Psychiatry 2018; 19:xx-xx)
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Keywords: metabolic syndrome, schizophrenia, bipolar disorder
Şizofreni ve bipolar bozuklukta metabolik sendrom yaygınlığının karşılaştırılması: Karadeniz bölgesinden kesitsel bir çalışma ÖZ Amaç: Bipolar bozukluk ve şizofrenide metabolik sendrom yaygınlığının normal popülasyondan fazla olduğuna ilişkin çalışmalar vardır. İki bozukluğu ayrı ayrı değerlendiren çalışmalar çok olmakla birlikte, karşılaştırmalı çalışmalar sayıca azdır. Literatürdeki bu eksikliğe dayanarak bu çalışmada bipolar ve şizofreni hastalarının metabolik sendrom yaygınlıklarının karşılaştırılması ve metabolik sendromun ilişkili olabileceği sosyodemografik ve klinik özelliklerin araştırılması amaçlanmıştır. Yöntem: Bu kesitsel çalışma KTÜ Hastanesi’nde özelleşmiş bir poliklinikte metabolik izlem programı tarafından izlenen, şizofreni (n=160) ve bipolar bozukluk (n=75) tanısı almış, en az sekiz haftadır antipsikotik kullanan toplam 235 hasta ile yürütülmüştür. Hastalara metabolik sendrom tanısı NCEP ATP-III ölçütlerine göre konulmuştur. Tüm sosyodemografik, klinik ve metabolik veriler, geriye dönük olarak hasta dosyaları ve elektronik tıbbi kayıtların incelenmesi ile elde edilmiştir. Bulgular: Örneklem genelinde metabolik sendrom yaygın_____________________________________________________________________________________________________ 1
MD, Fatih State Hospital, Psychiatry Clinic, Trabzon, Turkey MD, Prof. Dr., İstanbul Aydın University, School of Medicine, Department of Psychiatry, İstanbul, Turkey 3 Assist. Prof. Dr., Karadeniz Technical University, School of Medicine, Department of Psychiatry; 4 MD, Department of Public Health, Trabzon, Turkey Correspondence address / Yazışma adresi: Pınar KIZILAY ÇANKAYA, MD, Fatih State Hospital, Psychiatry Clinic, Trabzon, Turkey E-mail:
[email protected] Received: December, 13th 2017, Accepted: January, 05th 2017, doi: 10.5455/apd.285285 2
Anadolu Psikiyatri Derg 2018; 19:xx-xx
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Comparison of the prevalence of metabolic syndrome in patients with schizophrenia …
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lığı %32.3 olarak bulundu. Bel çevresi %60 yaygınlık ile en yaygın metabolik sendrom bileşeniydi. Metabolik sendrom ve bileşenleri açısından şizofreni (%31.3) ve bipolar hasta (%34.7) grubu arasında anlamlı fark bulunmadı. Yaş, beden kitle indeksi ve olanzapin, klozapin, ketiyapin, risperidondan oluşan antipsikotik grubu ilaçları kullanma durumu metabolik sendrom ile ilişkili bulundu. Sonuç: Metabolik sendrom ve bileşenleri, tanıdan bağımsız olarak şiddetli ruhsal bozukluklarda mortalite ve morbiditeyi artırması açısından üzerinde durulması gereken bir sağlık sorunudur. Özellikle yüksek risk taşıyan hastaların metabolik tarama ve izlemelerinin yapılması önemlidir. (Anadolu Psikiyatri Derg 2018; 19:xx-xx) Anahtar sözcükler: Metabolik sendrom, şizofreni, bipolar bozukluk _____________________________________________________________________________________________________
Patients with serious mental illness (SMI) such as schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder experience a two-three times higher mortality rate than general population, which means these individuals die 10 to 30 years younger than normal population.1-4 This mortality gap appears to be widening in recent decades despite the progress in health care systems.5
The prevalence of MetS among patients with either schizophrenia or bipolar disorder has been extensively studied. However, research comparing these disorders is relatively scarce with inconsistent findings.26,27 This study aimed to evaluate the prevalence of MetS and its components among patients with schizophrenia and bipolar disorder comparatively in addition to their associations with socio-demographic and clinical characteristics. To the best our knowledge this is the first study comparing the MetS prevalence in schizophrenia and bipolar patients within a Turkish population.
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About 60% of the excess mortality observed in SMI is due to physical comorbidities, predominantly cardiovascular diseases (CVD).6 Predisposing factors to cardiovascular disease in patients with SMI include antipsychotic (AP) medication use and unhealthy lifestyles7 as well as their reduced likelihood to receive standard levels of medical care.8-12 Although patients who never used APs still have higher fasting blood glucose and higher insulin resistance, it is well known that AP treatment further increases the emergence of risk factors such as metabolic imbalance and weight gain.13-15
prevalence in bipolar disorder. The same study showed an overall MetS frequency of 32.6% among patients with SMI.22
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INTRODUCTION
The concept of metabolic syndrome (MetS) has been introduced to assist clinicians in identifying and treating patients at an increased risk of CVD. MetS is defined by a combination of central obesity, high blood pressure, low high-density lipoprotein (HDL) cholesterol, elevated triglycerides, and hyperglycemia. In the general population, these clustered risk factors have been associated with the development of CVD and excess mortality.16-18 The MetS diagnosis provides the opportunity to identify high-risk populations and prevent the progression of some major causes of morbidity and mortality.19 The overall prevalence of MetS among patients with SMI ranges between 25% and 50%, with a relative risk of up to 2.0 compared to the general population.20-22 The prevalence of MetS among patients with schizophrenia was estimated to be 32.5% to 36.8%,22-24 and 37.3% among patients with bipolar disorders.25 A recent meta-analysis showed a prevalence of 33.4% MetS in schizophrenia, which also indicated a similar 31.7% Anatolian Journal of Psychiatry 2018; 19:xx-xx
METHODS
Study design and participants
This cross-sectional observational study was carried out at Karadeniz Technical University (KTU), School of Medicine, Department of Psychiatry, Schizophrenia and Bipolar Disorder Outpatient Clinic. Data were obtained retrospectively by reviewing the medical records by a trained psychiatric staff. The list of eligible patients with relevant diagnoses according to ICD10 was retrieved from the hospital electronic system. The patients between 18-65 years old and diagnosed with schizophrenia or bipolar disorder according to DSM-IV-TR between January 2007 and December 2014 were included in the first search. The diagnosis of the attending physician was considered a valid diagnosis. The presence of psychiatric comorbidity was not considered as exclusion criteria for the study. The first search yielded 3711 patients. The patients with a follow-up period of less than three months, final diagnosis changed in the follow-up period, and missing or contradictory data were excluded. The patients with mental retardation, alcohol or drug misuse, severe physical illness, and those diagnosed with diabetes, hypertension, or hyperlipidemia before the current psychiatric diagnosis were also excluded. Finally, data
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Diagnosis of metabolic syndrome (MetS)
Ethical statement Local approval was obtained from hospital administration for using the data on the hospital electronic system and patient files retrospectively. The study was approved by the Karadeniz Technical University School of Medicine Local Ethics Committee. RESULTS A total of 235 patients were included in the current analysis. The average age was 39.6 years; 55.7% of the patients were male and 44.3% were female. The overall MetS frequency was found to be 32.3% (n=76) based on the ATP-III criteria. The sociodemographic and clinical characteristics of the subjects in general and by MetS status are given in Table 1. These characteristics include the age distribution, the median duration of illness and antipsychotic (AP) exposure, psychiatric diagnosis, gender, employment, education, smoking, psychiatric comorbidity, family history for cardiovascular disorders (CVDs), etc.
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We used the definition by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) for MetS, which is the most commonly used MetS definition in the literature. Subjects met the criteria for MetS if three of the following ATP-III-defined criteria were present: i) waist circumference >102 cm in men or >88 cm in women; ii) elevated serum triglyceride ≥150 mg/dL; iii) low serum HDL cholesterol (
