Metabolic changes, inflammation and mortality in psychotic disorders
Year: 2018
Type: dissertation
Study design: Observational Study
Abstract: People with psychotic disorders have an increased risk of obesity, cardiovascular disease and diabetes. Together with a high risk for suicide, these lead to a reduction of the average lifespan by 15-20 years. Identifying clinical predictors of cardiovascular disease and mortality in psychotic disorders is important. This study examined anthropometric measures and lipid and glucose metabolism in people with first-episode psychosis (FEP). Predictors of weight gain and increased waist circumference were analysed. In addition, predictors of systemic low-grade inflammation as measured by high-sensitivity C-reactive protein (hs-CRP), an independent risk factor for cardiovascular disease and mortality, were examined. This study also investigated mortality and factors associated with mortality risk in non-affective psychosis (NAP) during a 13-year follow-up using data from the Health 2000 Study. People with FEP and healthy controls had similar body mass index, waist circumference, hs-CRP and fasting glucose at study baseline. The levels of total and low-density lipoprotein cholesterol, triglyceride, insulin and insulin resistance were increased in FEP as compared to controls already at baseline. Glucose and lipid parameters did not change significantly during the follow-up in FEP. However, marked weight gain (median 9.6 kg) and increase in waist circumference (6.0 cm) were observed during the first year of treatment. Insulin resistance and olanzapine medication at baseline predicted more weight gain during the follow-up. Insulin resistance also predicted increase in waist circumference. An over 2.5-fold increase in hs-CRP was observed during the follow-up in FEP, and the levels of hs-CRP were strongly related to waist circumference and female gender. The mortality risk in NAP was increased threefold, and remained increased over twofold when adjusted for known risk factors for mortality. Antipsychotic medication use was associated with lower natural-cause mortality risk, and smoking with increased risk. In line with previous studies, people with FEP had a significant increase in body weight and waist circumference during the first year of treatment of the psychotic disorder. Insulin resistance predicted weight gain and abdominal obesity, which is a novel and clinically important finding. Low-grade inflammation was strongly related to the increase in abdominal adiposity, suggesting that hs-CRP is primarily a marker of metabolic risk in people with FEP. Smoking cessation should be promoted to reduce the excess mortality in psychotic disorders. Improving detection and quality of treatment of physical diseases in people with psychotic disorders seems necessary to prevent premature mortality.
Source: Työväentutkimus Vuosikirja
Author: Keinänen, Jaakko
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2911912755