title: Metabolic syndrome or glucose challenge in first episode of psychosis?
abstract: Patients with schizophrenia exhibit a reduced life expectancy. Although unhealthy lifestyle or suicide risk plays a role, the main causes are diverse medical conditions such as cardiovascular diseases, type 2 diabetes mellitus and metabolic syndrome. Albeit pharmacological secondary side effects might also trigger previous conditions, studies in naïve patients reflect diverse anomalies at the onset. Patients with a first episode of psychosis, display a wide scope of metabolic abnormalities, ranging from normality till pathological values depending on the parameters studied. We attempted to evaluate the metabolic syndrome and glycemic homeostasis in a subset of antipsychotic-naïve patients with a first episode of non-affective psychosis. Patients (n=84) showed a similar prevalence of metabolic syndrome compared with a matched control sample (n=98) (6% vs 4%, P=0.562), while glucose homeostasis values differed significantly (14% vs. 5%, P=0.034). Our results suggest that metabolic syndrome is not a useful clinical condition to be evaluated in patients before pharmacological treatment. Abnormal glycemic homeostasis at the onset of the disease requires specific diagnostic tools and preventive measures in order to avoid future cardiovascular events. New strategies must be implemented in order to evaluate the cardiovascular risk and subsequent morbidity in patients at the onset of the disease.
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: cgarcia3@clinic.ub.es.
authors.forename: C
authors.initials: C
authors.lastname: Garcia-Rizo
authors.affiliation: Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, CB2 0QQ Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon PE29 3RJ, UK.
authors.forename: E
authors.initials: E
authors.lastname: Fernandez-Egea
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Oliveira
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Meseguer
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Cabrera
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Mezquida
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bioque
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Penades
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Parellada
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bernardo
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: B
authors.initials: B
authors.lastname: Kirkpatrick
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000523:psychology; D015995:Prevalence; D011618:Psychotic Disorders / Q000097:blood / Q000175:diagnosis; D012307:Risk Factors; D012559:Schizophrenia / Q000378:metabolism / Q000503:physiopathology; D013030:Spain / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose
keywords: Antipsychotic-naïve; First episode; Metabolic syndrome; Oral glucose tolerance test; Psychosis; Thrifty psychiatric phenotype