Metabolic risk factors in drug-naive patients with first-episode psychosis.
OBJECTIVE
Metabolic risk factors, such as obesity, as well as abnormalities in glucose and lipid metabolism, have been shown to have an increased prevalence in patients with schizophrenia, especially in those treated with antipsychotic medication. However, studies looking at these abnormalities in drug-naive patients have been few in number and have yielded mixed results. The aim of our study was to look at the prevalence of some of the cardiovascular risk factors, such as obesity and lipid and glucose abnormalities, in drug-naive patients with first-episode psychosis compared to healthy controls matched for age, gender, and ethnicity.


METHODS
One hundred sixty patients aged between 18 and 40 years who presented to the Early Psychosis Intervention Programme in Singapore with a diagnosis of first-episode psychosis according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition were assessed for their body mass index (BMI) and plasma levels of fasting glucose and lipids. The results of this assessment were compared to similar data from 200 controls matched for age, gender, and ethnicity, collected as part of an annual workplace health screening. The study was conducted from June 2002 to March 2005.


RESULTS
There were significant differences in the mean baseline weight, BMI, and plasma levels of total and LDL cholesterol; all of these values were significantly higher in the controls compared to patients (p < .005 for all). Controls were significantly more likely to have high BMI (>or= 23 kg/m(2)) and high LDL cholesterol level (> 3.4 mmol/L) as compared to patients (p < .005 and p = .01, respectively). However, patients compared to controls were significantly more likely to have diabetes (p = .007).


CONCLUSIONS
The link between diabetes and psychotic illness previously reported in relatives of patients with schizophrenia and in medication-naive patients implies a possible genetic link between schizophrenia and abnormal glucose metabolism. However, the finding of low prevalence of obesity and dyslipidemia at the onset of illness suggests that the increased frequency of these abnormalities in patients is an effect of their antipsychotic medication.
Verma
Swapna K
SK
Early Psychosis Intervention Programme, Institute of Mental Health/Woodbridge Hospital, Singapore. Swapna_VERMA@imh.com.sg
Subramaniam
Mythily
M
Liew
Alvin
A
Poon
Lye Yin
LY
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D050171:Dyslipidemias / Q000097:blood / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D012307:Risk Factors; D012559:Schizophrenia / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology
D014150:Antipsychotic Agents; D001786:Blood Glucose; D008078:Cholesterol, LDL