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Abstract
BackgroundAlthough the validity and safety of antipsychotic polypharmacy remains unclear, it is commonplace in the treatment of schizophrenia. This study aimed to investigate the degree that antipsychotic polypharmacy contributed to metabolic syndrome in outpatients with schizophrenia, after adjustment for the effects of lifestyle.MethodsA cross-sectional survey was carried out between April 2007 and October 2007 at Yamanashi Prefectural KITA hospital in Japan. 334 patients consented to this cross-sectional study. We measured the components consisting metabolic syndrome, and interviewed the participants about their lifestyle. We classified metabolic syndrome into four groups according to the severity of metabolic disturbance: the metabolic syndrome; the pre-metabolic syndrome; the visceral fat obesity; and the normal group. We used multinomial logistic regression models to assess the association of metabolic syndrome with antipsychotic polypharmacy, adjusting for lifestyle.ResultsSeventy-four (22.2%) patients were in the metabolic syndrome group, 61 (18.3%) patients were in the pre-metabolic syndrome group, and 41 (12.3%) patients were in visceral fat obesity group. Antipsychotic polypharmacy was present in 167 (50.0%) patients. In multinomial logistic regression analyses, antipsychotic polypharmacy was significantly associated with the pre-metabolic syndrome group (adjusted odds ratio [AOR], 2.348; 95% confidence interval [CI], 1.181-4.668), but not with the metabolic syndrome group (AOR, 1.269; 95%CI, 0.679-2.371).ConclusionsThese results suggest that antipsychotic polypharmacy, compared with monotherapy, may be independently associated with an increased risk of having pre-metabolic syndrome, even after adjusting for patients' lifestyle characteristics. As metabolic syndrome is associated with an increased risk of cardiovascular mortality, further studies are needed to clarify the validity and safety of antipsychotic polypharmacy.
Highlights
The validity and safety of antipsychotic polypharmacy remains unclear, it is commonplace in the treatment of schizophrenia
Seventy-four (22.2%) patients were in the metabolic syndrome group, 61 (18.3%) patients were in the pre-metabolic syndrome group, 41 (12.3%) patients were in the visceral fat obesity group, and 158 (47.3%) were in the normal group
Our study is the first attempt to clarify the relationship between metabolic syndrome, antipsychotic polypharmacy, and patients’ lifestyle
Summary
The validity and safety of antipsychotic polypharmacy remains unclear, it is commonplace in the treatment of schizophrenia. Metabolic syndrome is a cluster of metabolic dysfunctions, including central obesity, hypertension, glucose, and lipid abnormalities. Those with the syndrome have a two- to threefold increase in cardiovascular mortality and a twofold increase in all-cause mortality [1]. If antipsychotic polypharmacy, which is not recommended, is associated with a greater risk of metabolic syndrome, the spread of polypharmacy is a serious concern It remains unclear among earlier studies whether antipsychotic polypharmacy is associated with metabolic syndrome as a direct result of patients’ unhealthy lifestyle. Patients with schizophrenia are likely to make poor dietary choices, have low rates of physical activity, and smoke cigarettes [13], and their unhealthy lifestyle is assumed to be associated with an increased risk of metabolic syndrome. As little information is available on the association between metabolic syndrome and antipsychotic polypharmacy in conjunction with patients’ lifestyle, further research is needed any such association
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