title: Is antipsychotic polypharmacy associated with metabolic syndrome even after adjustment for lifestyle effects?: a cross-sectional study.
abstract: BACKGROUND
  Although 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Seventy-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).
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: Yamanashi Prefectural KITA Hospital, 3314-13 Kamijominamiwari, Asahi-machi, Nerasaki-shi, Yamanashi, Japan. misawa-ahme@ych.pref.yamanashi.jp
authors.forename: Fuminari
authors.initials: F
authors.lastname: Misawa
authors.forename: Keiko
authors.initials: K
authors.lastname: Shimizu
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Fujii
authors.forename: Ryouji
authors.initials: R
authors.lastname: Miyata
authors.forename: Fumio
authors.initials: F
authors.lastname: Koshiishi
authors.forename: Mihoko
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Shida
authors.forename: Yoshiyo
authors.initials: Y
authors.lastname: Oguchi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Okumura
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ito
authors.forename: Mami
authors.initials: M
authors.lastname: Kayama
authors.forename: Haruo
authors.initials: H
authors.lastname: Kashima
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents