Abstract
A high prevalence of metabolic syndrome and its components in patients with psychotic disorders may increase the risk for cardiovascular diseases. Unfortunately, relatively little work in this field has emerged from low-resourced contexts. This study investigated the prevalence, correlates, and treatment patterns of metabolic disorders in patients with psychotic disorders in Western Kenya. 300 patients with psychosis and 300 controls were recruited at Moi Teaching and Referral Hospital in Eldoret, Kenya. Data on demographic characteristics, weight, height, abdominal circumference, blood pressure, blood glucose, lipid profile, and treatments were collected. Categorical and continuous data were compared between the patient and control groups using Pearson's chi-squared tests and t-tests, respectively. Variables found to be significantly different between these groups were included in logistic regression models to determine potential predictors of metabolic syndrome. Compared to controls, patients with psychosis were found to have a higher mean random blood glucose [5.23 vs 4.79, p = 0.003], higher body mass index [5.23 vs 4.79, p = 0.001], higher triglycerides [1.98 vs 1.56, p<0.001], larger waist circumference [89.23 vs 86.39, p = 0.009] and lower high density lipoprotein [1.22 vs 1.32, p<0.001]. The odds of developing metabolic syndrome were increased with age [OR = 1.05, CI: 1.02-1.07] and presence of a psychotic disorder [OR = 2.09 [CI 1.23-3.55]; and were reduced with female gender [OR 0.41, CI 0.25-0.67], among those who were never married [OR 0.52, CI 0.28-0.94] and among the widowed/separated/ divorced marital status [OR 0.38, CI 0.17-0.81]. While the majority of patients received treatment with olanzapine, there was no association between olanzapine use and metabolic syndrome and its components. More than half of the patients in this study sample were not receiving treatment for the various components of metabolic syndrome. In the study setting of Eldoret, metabolic syndrome and its components were more prevalent among patients with psychotic disorders than in controls; and a clear treatment gap for these disorders was evident. There is a need for efforts to ensure adequate screening and treatment for these physical disorders in resource-limited settings.
Highlights
Cardiovascular disorders [CVDs] are the leading cause of death worldwide [1]; and there is evidence to suggest an increased risk among patients with psychosis compared to the general population [2, 3]
The odds of developing metabolic syndrome were increased with age [OR = 1.05, CI: 1.02–1.07] and presence of a psychotic disorder [OR = 2.09 [CI 1.23–3.55]; and were reduced with female gender [OR 0.41, CI 0.25–0.67], among those who were never married [OR 0.52, CI 0.28–0.94] and among the widowed/separated/ divorced marital status [OR 0.38, CI 0.17–0.81]
Neuropsychiatric Genetics of African Populations (NeuroGAP) - Psychosis study hosted at the Stanley Global at the Broad Institute and the Harvard T.H Chan School of public health, USA
Summary
Cardiovascular disorders [CVDs] are the leading cause of death worldwide [1]; and there is evidence to suggest an increased risk among patients with psychosis compared to the general population [2, 3]. In patients with psychotic disorders, the prevalence of metabolic syndrome is estimated at 30% [5], diabetes at 10% [6], and hypertension at 20% [7] This high burden of co-morbidity of psychotic disorders and metabolic syndrome and its components has been found to contribute significantly to the excess mortality in this population [8, 9]; and has partly been attributed to the use of antipsychotics [primarily clozapine and olanzapine] [10]. The need for further literature in resource-limited settings is highlighted by compelling evidence from the World Health Organization [WHO] that approximately 75% of all reported CVD-related deaths in the general population take place in LMICs [15]. This study investigated the prevalence, correlates, and treatment patterns of metabolic disorders in patients with psychotic disorders in Western Kenya
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