Journal Digest

The duration of psychiatric illness and treatment for patients after first-episode schizophrenia spectrum disorders (FES) appears to be associated with weight gain and having other cardiometabolic abnormalities, according to a study in JAMA Psychiatry.

Researchers from the Department of Psychiatry at Zucker Hillside Hospital in New York led a study with approximately 400 FES patients to assess cardiometabolic risk in FES and its relationship to illness duration and antipsychotic treatment.

The analysis showed that after patients experienced their FES, nearly 50 percent were obese or overweight, 40 percent had prehypertension, 10 percent had hypertension, and 13.2 percent had some form of metabolic syndrome.

Total psychiatric illness duration correlated significantly with higher body-mass index, fat percentage, and waist circumference. Treatment with antipsychotic medications such as olanzapine and quetiapine were associated with higher triglyceride levels in the blood.

The researchers concluded that “in patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse-effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.”

Multiple psychiatric disorders are prevalent among juvenile offenders. However, far less is known about the mental state of the young people after they leave detention. Researchers from Northwestern University Feinberg School of Medicine led a study investigating the odds that a young person with a disorder at a juvenile detention center will have the same disorder three and five years later.

The study included data from follow-up interviews—conducted five years after being released from detention centers—of more than 1,800 individuals who were detained from 1995 to 1998. The average age of participants during follow-ups was 20 years.

Results showed that almost 27 percent of the males and 14 percent of the females had two or more psychiatric disorders. In males, the most common psychiatric disorder profile was substance use plus behavior disorders, which affected 1 in 6 males in the study. Among youth who had three or more psychiatric disorders at baseline, almost all of the males and three-quarters of the females had one or more disorders five years later.

As the researchers pointed out, “Early-onset psychiatric disorders are among the illnesses ranked highest in the World Health Organization’s estimates of the global burden of disease, creating annual costs of $247 billion in the United States. Successful primary and secondary prevention of psychiatric disorders will reduce costs to individuals, families, and society. Only a concerted effort to address the many needs of delinquent youth will help them thrive in adulthood.”

People with severe mental illness who commit a crime and are incarcerated have characteristics that differentiate them from their counterparts who are court-ordered into psychiatric hospitals after committing an offense, according to researchers from the University of Montreal.

Socioeconomic and clinical profiles of 100 male offenders with serious mental illness were analyzed by Canadian psychiatrists to compare the characteristics of individuals who were incarcerated with those of individuals who were placed in a forensic psychiatric care unit.

The analysis showed that those incarcerated had experienced more suicide attempts, had engaged in more criminal activity, and were nearly three times more likely to have a concomitant substance or alcohol use disorder than the hospitalized cohort. Those who received court-ordered hospitalization were more likely to have higher education levels and past use of specialized mental health services.

“The characteristics of incarcerated people put them on a path to criminal behavior and prevented them from getting the psychiatric care they need,” stated the study’s lead author, Alexandre Dumais, M.D., Ph.D. “People who commit an offense need to serve their time, but they also need care if they suffer from an illness. New shared-care models between the legal and health care systems need to be implemented so that these patients can get better treatment and so that we can reduce their risk of violent and antisocial behavior. Some countries have launched initiatives in this area, but these programs haven’t been formally tested with rigorous research methods. Further studies should look at these models to determine which ones are effective.”

Researchers at the Memory and Aging Center at the University of California, San Francisco (USCF), conducted a longitudinal study in nearly 3,500 adults to assess whether an association existed between exposure to cardiovascular risk factors and adverse lifestyle behaviors (for example, physical inactivity and poor diet) in early adulthood and cognitive decline in midlife. Study participants were followed from early adulthood (ages 18 to 30) through midlife (ages 43 to 55).

The results, presented at last month’s annual meeting of the American College of Neuropsychopharmacology in Phoenix, showed that some risk factors such as elevated blood pressure and low physical activity over the 25-year course of the study were associated with worse cognitive performance in midlife, measured by multiple cognitive tests such as the Stroop Interference Score and the Rey Auditory Verbal Learning Test.

The study’s presenter, Kristin Yaffe, M.D., a professor of psychiatry at UCSF, stated that the current findings represent a critical step in the identification of antecedents of diseases of aging—in this case, cognitive impairment—many years before such conditions are diagnosed. Yaffe concluded that “understanding that processes of cumulative risk for cognitive diseases of aging start early in adulthood provides a real opportunity for early identification and the use of prevention interventions for those at risk.”

A study from the Centers for Disease Control and Prevention and the University of Pennsylvania suggests that people with a mental illness diagnosis are more likely to receive HIV testing than those without mental disorders.

The study assessed health records of more than 21,000 participants from the 2007 National Health Interview Survey, which included information on both mental health diagnoses and HIV testing.

The researchers found that 15 percent of respondents reported a psychiatric disorder. Among those reporting at least one mental illness, 48.5 percent had been tested for HIV, compared with 35 percent of those without mental illness. People with schizophrenia and bipolar disorder were almost 1.5 times more likely to report being tested for HIV than those with depression or an anxiety disorder.

“Our study shows that persons with mental illness and/or their care providers recognize that this patient population is at higher risk and should be tested,” said senior author Michael Blank, Ph.D., codirector of the Penn Mental Health AIDS Research Center. “However, by no means should we be complacent, since these results may in large part be due to individual vigilance. In light of the fact that mentally ill people are more likely to engage in risky behavior, mental health providers should consider routinely offering HIV/AIDS testing, something that does not typically occur now.” ■