Abstract
Background: Severe mental illnesses are associated with increased risks for metabolic syndrome (MetS) and other medical disorders, often with unfavorable outcomes. MetS may be more likely with schizoaffective disorder (SzAff) than schizophrenia (Sz). MetS is associated with long-term antipsychotic drug treatment, but relative risk with orally administered vs. long-acting injected (LAI) antipsychotics is uncertain.Methods: Subjects (n = 151 with a DSM-IV-TR chronic psychotic disorder: 89 Sz, 62 SzAff), treated with oral or LAI antipsychotics were compared for risk of MetS, initially with bivariate comparisons and then by multivariate regression modeling.Results: Aside from measures on which diagnosis of MetS is based, factors preliminarily associated with MetS included antipsychotic drug dose, “high-risk” antipsychotics associated with weight-gain, older age and female sex. Defining factors associated with diagnosis of MetS ranked in multivariate regression as: higher fasting glucose, lower LDL cholesterol, higher diastolic blood pressure, and higher BMI. Risk of MetS with antipsychotics ranked: quetiapine ≥ clozapine ≥ paliperidone ≥ olanzapine ≥ risperidone ≥ haloperidol ≥ aripiprazole. Other associated risk factors in multivariate modeling ranked: higher antipsychotic dose, older age, and SzAff diagnosis, but not oral vs. LAI antipsychoticsConclusions: SzAff diagnosis and higher antipsychotic doses were associated with MetS, whereas orally vs. injected antipsychotics did not differ in risk of MetS.
Highlights
Persons with severe mental illnesses have increased risk for metabolic disorders, including metabolic syndrome (MetS), characterized by obesity, type 2 diabetes mellitus, dyslipidemia, and hypertension [1]
Few studies have compared physical health of subjects diagnosed with schizoaffective disorder (SzAff) to that of other patients with other psychotic-disorder diagnoses, including Sz, but SzAff patients may have a greater risk of MetS than those with other major psychiatric disorders [6]
Antipsychotics were combined with moodstabilizers (MSs) in only 14.5%, or with antidepressants (ADs) in 12.3%
Summary
Persons with severe mental illnesses have increased risk for metabolic disorders, including metabolic syndrome (MetS), characterized by obesity, type 2 diabetes mellitus, dyslipidemia, and hypertension [1]. Such disorders appear to be related to an unhealthy diet, lack of regular exercise, adverse effects of psychotropic drugs, and possibly to undefined risk factors associated with the illnesses themselves [2, 3]. SzAff patients are characterized by emotional and behavioral instability over time as well as psychotic features, and often are treated with relatively complex pharmacological regimens [7] Both emotional instability and complex treatments may contribute to an increased risk of metabolic disorders [1]. MetS is associated with long-term antipsychotic drug treatment, but relative risk with orally administered vs. long-acting injected (LAI) antipsychotics is uncertain
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