Patients With Severe Disorders At Risk for Multiple Illnesses
Nearly 40 percent of patients admitted to an inpatient unit with psychotic or mood disorders were found to have metabolic syndrome—a constellation of signs and symptoms that, taken together, are an intermediate step in the development of type II diabetes, cardiovascular disease, and ultimately a significantly elevated risk of early death.
The finding comes from a new report by Richard Bermudes, M.D., now an assistant clinical professor of psychiatry at the University of California, Davis, and colleagues in the December 2006, Psychosomatics. The research was completed without outside funding while Bermudes was a junior attending at the University of Cincinnati Medical Center.
Bermudes and his coauthors noted that the widespread and growing use of second-generation antipsychotics (SGAs) for off-label indications and patient populations has been well documented over the last five to seven years. Numerous peer-reviewed reports have also detailed the propensity of as many as 30 percent of patients taking the medications to experience a gain of more than 10 percent of their baseline weight after beginning treatment with an SGA.
In addition, SGAs have been associated with elevations of serum triglycerides, cholesterol, and abnormalities in glucose metabolism, all of which are signals of impending metabolic syndrome. Other research, Bermudes added, indicated that patients with severe psychiatric disorders have elevated rates of cardiovascular disease and diabetes.
Therefore, Bermudes and his colleagues hypothesized that a group of patients with primary psychotic and mood disorders who are taking SGAs would be at especially high risk of having metabolic syndrome.
They studied 102 adult patients with a primary diagnosis of a mood or psychotic disorder admitted to the inpatient psychiatry service at the University of Cincinnati Medical Center from November 2003 through March 2004. The researchers retrospectively collected data on height, weight, clinical laboratory findings (including fasting triglyceride, HDL cholesterol, and glucose levels), and blood pressure.
Metabolic syndrome was defined using the following diagnostic guidelines in the Third Report of the National Cholesterol Education Program Adult Treatment Panel (ATP III):
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Waist circumference greater than 40 inches in men or 35 inches in women
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Elevated serum triglycerides higher than 150mg/dL
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Low serum HDL (less than 40mg/dL in men or less than 50 mg/dL in women
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Systolic blood pressure above 130 mm Hg or diastolic pressure above 85 mg Hg)
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Fasting plasma glucose level above 110 mg/dL).
In accordance with the ATP III guidelines, patients in the study were said to have metabolic syndrome if three of the five criteria were present.
Overall, 38.6 percent of the group of severely ill psychiatric inpatients met criteria for metabolic syndrome. Bermudes noted that the Third National Health and Nutrition Examination Survey (NHANES III), which collected patient data from 1988 through 1994, estimated the rate of metabolic syndrome in the general population to be about 21 percent.
In the cohort of patients studied by Bermudes and colleagues, those with metabolic syndrome were significantly older (average age 44 compared with 35 for those without metabolic syndrome), had larger waist circumferences (46.3 inches compared with 38.4 inches), and larger body mass indices (34.9 versus 27). Metabolic syndrome was also associated with Caucasian ethnicity and higher incomes.
“Our study indicated that more than 2 in 3 mentally ill patients had the metabolic syndrome and therefore harbored what is usually a clinically silent and unidentified elevated risk for cardiovascular disease and type II diabetes,” Bermudes and his colleagues said.
“Psychiatrists should consider measuring [blood pressure] and waist circumference, two components of the metabolic syndrome, which are easily assessed in the office setting,” they suggested. In this sample, patients who had elevated blood pressure and large waist circumference met criteria for the full metabolic syndrome 86 percent of the time.
“All patients taking atypical antipsychotics require monitoring of weight, fasting glucose, and lipids,” the researchers concluded.“ Failure to monitor metabolic parameters and intervene early may result in continued high rates of morbidity in severely mentally ill patients secondary to complications of [cardiovascular disease] and diabetes.”
Because the root causes of metabolic syndrome for a majority of individuals with chronic mental illness may be poor diet, insufficient physical activity, and side effects from medications, “the high prevalence of the syndrome underscores an urgent need to develop comprehensive efforts directed at controlling the obesity epidemic and improving physical activity levels within the population of chronic mentally ill patients.”
“The Prevalence of the Metabolic Syndrome in Psychiatric Inpatients With Primary Psychotic and Mood Disorders” is posted at<www.psy.psychiatryonline.org/cgi/content/abstract/47/6/491>.▪
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Published online: 5 January 2007
Published in print: January 5, 2007
Notes
The evidence is overwhelming: metabolic syndrome is common in patients with psychiatric disorders and needs to be monitored and treated.
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