Prevalence of Metabolic Syndrome During 1 Year After the First Episode of Psychosis
Portuguese authors elucidated the high prevalence of metabolic syndrome and adverse metabolic parameters in individuals with the first episode of psychosis. Moreover, it significantly increased during 1 year after this episode.
CV Risk In Individuals with Psychotic Disorders
The life expectancy of patients with psychotic disorders is 13–30 years shorter than in the general population. The main reason for their increased mortality is not only suicides but primarily cardiovascular (CV) diseases. Metabolic syndrome, which carries high CV risk, is the focus of a recently published longitudinal study that assessed the occurrence of metabolic abnormalities at the time of the first episode of psychosis and their development over the following year.
Evaluated Patient Population and Monitored Parameters
Included were 60 patients from a university hospital in Lisbon aged 16–40 years. The average age was 27.1 years, with 66.7% being men. Most participants (95%) were hospitalized during their first episode of psychosis. The average duration of untreated psychotic symptoms was 313 days. The most common diagnosis was schizophrenia spectrum disorders (50% of cases), followed by affective psychosis (26.7%).
The presence of metabolic syndrome was assessed as the occurrence of ≥ 3 of the following parameters:
- Waist circumference > 102 cm in men and > 88 cm in women
- Triglycerides (TG) level > 1.7 mmol/l or use of lipid-lowering medications
- High blood pressure (≥ 130/≥ 85 mmHg) or use of antihypertensive medications
- Low HDL cholesterol level (< 1.04 mmol/l in men and < 1.3 mmol/l in women)
- High fasting glucose level (≥ 5.6 mmol/l) or a diagnosis of type 2 diabetes
The authors also analyzed metabolic parameters and sociodemographic and psychopathological data of these patients during 1 year after the first episode of psychosis.
Results
The prevalence of metabolic syndrome was 6.7% at the time of the first episode of psychosis and increased to 11.7% over the next year, which is a statistically insignificant increase (p = 0.250). However, there was a significant increase in the prevalence of enlarged waist circumference (from 10% to 21.7%; p = 0.039), elevated TG levels (from 6.7% to 10%; p = 0.040), and reduced HDL-c levels (from 21.7% to 25%; p = 0.019). The proportion of patients with ≥ 2 components of metabolic syndrome increased from 15% to 26.6%.
No evaluated initial parameter predicted the development of metabolic syndrome within 1 year after the first psychotic episode.
Conclusion
These findings indicate a high prevalence of metabolic syndrome in individuals with the first episode of psychosis. Moreover, the occurrence of metabolic abnormalities increases in these patients over the following year. Further studies are needed to evaluate the impact of various interventions on metabolic parameters and cardiovascular morbidity and mortality in these patients. It will also be important to assess the impact of second-generation antipsychotics on metabolic parameters.
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Source: Coentre R., Levy P., Góis C., Figueira M. L. Metabolic syndrome following a first episode of psychosis: results of a 1-year longitudinal study conducted in metropolitan Lisbon, Portugal. J Int Med Res 2022 Jun; 50 (6): 3000605221106703, doi: 10.1177/03000605221106703.
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