Metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. The primary aim of this systematic review and meta-analysis was to assess the prevalence of MetS and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder, comparing subjects with different disorders and taking into account demographic variables and psychotropic medication use. The secondary aim was to compare the MetS prevalence in persons with any of the selected disorders versus matched general population controls. The pooled MetS prevalence in people with severe mental illness was 32.6% (95% CI: 30.8%-34.4%; N 5 198; n 5 52,678). Relative risk meta-analyses established that there was no significant difference in MetS prevalence in studies directly comparing schizophrenia versus bipolar disorder, and in those directly comparing bipolar disorder versus major depressive disorder. Only two studies directly compared people with schizophrenia and major depressive disorder, precluding meta-analytic calculations. Older age and a higher body mass index were significant moderators in the final demographic regression model (z 5 23.6, p 5 0.0003, r 2 5 0.19). People treated with all individual antipsychotic medications had a significantly (p<0.001) higher MetS risk compared to antipsychotic-na€ ıve participants. MetS risk was significantly higher with clozapine and olanzapine (except vs. clozapine) than other antipsychotics, and significantly lower with aripiprazole than other antipsychotics (except vs. amisulpride). Compared with matched general population controls, people with severe mental illness had a significantly increased risk for MetS (RR 5 1.58; 95% CI: 1.35-1.86; p<0.001) and all its components, except for hypertension (p 5 0.07). These data suggest that the risk for MetS is similarly elevated in the diagnostic subgroups of severe mental illness. Routine screening and multidisciplinary management of medical and behavioral conditions is needed in these patients. Risks of individual antipsychotics should be considered when making treatment choices.Key words: Metabolic syndrome, severe mental illness, schizophrenia, bipolar disorder, major depressive disorder, antipsychotics (World Psychiatry 2015;14:339-347) People with severe mental illness (SMI), including schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder (MDD), experience a twothree times higher mortality rate than the general population (1,2). This mortality gap translates into a 10-20 year shortened life expectancy (3,4) and appears to be widening (5). About 60% of the excess mortality observed in SMI is due to physical comorbidities, predominantly cardiovascular diseases (CVD) (6). Factors predisposing people with SMI to CVD include antipsychotic medication and unhealthy lifestyles (7) as well as their reduced likelihood to receive standard levels of medical care (8-12).To assist clinicians in identifying and treating patients at an increased risk...

A systematic electronic PubMed, Medline and Web of Science database search was conducted regarding the prevalence, correlates, and effects of personal stigma (i.e., perceived and experienced stigmatization and self-stigma) in patients with schizophrenia spectrum disorders. Of 54 studies (n55,871), published from 1994 to 2011, 23 (42.6%) reported on prevalence rates, and 44 (81.5%) reported on correlates and/or consequences of perceived or experienced stigmatization or self-stigma. Only two specific personal stigma intervention studies were found. On average, 64.5% (range: 45.0-80.0%) of patients perceived stigma, 55.9% (range: 22.5-96.0%) actually experienced stigma, and 49.2% (range: 27.9-77.0%) reported alienation (shame) as the most common aspect of self-stigma. While socio-demographic variables were only marginally associated with stigma, psychosocial variables, especially lower quality of life, showed overall significant correlations, and illness-related factors showed heterogeneous associations, except for social anxiety that was unequivocally associated with personal stigma. The prevalence and impact of personal stigma on individual outcomes among schizophrenia spectrum disorder patients are well characterized, yet measures and methods differ significantly. By contrast, research regarding the evolution of personal stigma through the illness course and, particularly, specific intervention studies, which should be conducted utilizing standardized methods and outcomes, are sorely lacking.

No abstract

A meta-analysis was conducted to explore the risk for cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia and age- and gender- or cohort-matched general population controls. Our literature search generated 203 relevant studies, of which 136 were included. The final dataset comprised 185,606 unique patients with schizophrenia, and 28 studies provided data for age- and gender-matched or cohort-matched general population controls (n=3,898,739). We found that multi-episode patients with schizophrenia were at increased risk for abdominal obesity (OR=4.43; CI=2.52-7.82; p<0.001), hypertension (OR=1.36; CI=1.21-1.53; p<0.001), low high-density lipoprotein cholesterol (OR=2.35; CI=1.78-3.10; p<0.001), hypertriglyceridemia (OR=2.73; CI=1.95-3.83; p<0.001), metabolic syndrome (OR=2.35; CI=1.68-3.29; p<0.001), and diabetes (OR=1.99; CI=1.55-2.54; p<0.001), compared to controls. Multi-episode patients with schizophrenia were also at increased risk, compared to first-episode (p<0.001) and drug-naïve (p<0.001) patients, for the above abnormalities, with the exception of hypertension and diabetes. Our data provide further evidence supporting WPA recommendations on screening, follow-up, health education and lifestyle changes in people with schizophrenia.

The present findings strongly indicate that persons with MDD are a high-risk group for MetS and related cardiovascular morbidity and mortality. MetS risk may be highest in those prescribed antipsychotics.

Intensive repeated measurement techniques, such as the experience sampling method (ESM), put high demands on participants and may lead to low response compliance, which in turn may affect data quality. Therefore, the objective of this study was to investigate ESM compliance and predictors thereof based on a pooled dataset of 10 ESM studies with a total of 92,394 momentary assessments from 1,717 individuals with different mental health conditions. All included studies used an ESM paper-and-pencil diary protocol of 4 to 6 study days with 10 random time assessments per day. Analyses were conducted using multilevel mixed-effects logistic regression models. Results indicated overall acceptable compliance with an average 3 response rate of 78% (95%CI 0.74 to 0.82). However, compliance declined across days (p<.001), reaching a low on the 5th day with 73% (95%CI: 0.68 to 0.77). Compliance also varied significantly across assessments depending on the time within a day (p<.001), with highest compliance between 12 p.m. and 1.30 p.m. (83%; 95%CI: 0.80 to 0.86) and lowest compliance between 7.30 a.m. and 9 a.m. (56%; 95%CI: 0.50 to 0.62). Persons with psychosis were less compliant than healthy participants (70% vs. 83%, respectively; p<.001). Also females (p=.002) and older participants (p<.001) were slightly more compliant. The findings suggest acceptable compliance in an ESM protocol of 4 to 6 study days with a high frequency of 10 assessments per day despite fluctuations across and within study days. Further evidence on compliance and its predictors in different ESM protocols is needed, especially in clinical populations.

The presence of the metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of MetS in patients with schizophrenia at the onset of the disorder and specifically no data on patients treated in the era when only first-generation antipsychotics were available.Methods: Data from a historic cohort of consecutively admitted first-episode patients with schizophrenia treated with first-generation antipsychotics (FGAs) were compared with an age and sex matched series of consecutive first-episode patients treated only with second-generation antipsychotics (SGAs). Rates of MetS were compared at baseline and after on average 3 years of treatment exposure.Results: At first episode there was no difference in the prevalence of MetS between the historic and the current cohort. Rates of MetS increased over time in both groups, but patients started on SGAs had a three times higher incidence rate of MetS (Odds Ratio 3.6, CI 1.7-7.5). The average increase in weight and body mass index was twice as high in patients started on SGA. The difference between the FGA and SGA group was no longer significant when patients started on clozapine and olanzapine were excluded. Conclusion:Rates of MetS at the first episode of schizophrenia today are not different from those of patients 15 to 20 years ago. This finding counters the notion that the high rates of metabolic abnormalities in patients with schizophrenia currently reported are mainly due to lifestyle changes over time in the general population. Some SGAs have a significantly more negative impact on the incidence of MetS compared to FGAs in first-episode patients.

Objectives: The presence of metabolic abnormalities is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of the metabolic abnormalities in disorders other than schizophrenia in which antipsychotic medication is part of routine treatment.Methods: Sixty consecutive patients with bipolar disorder (BD) at our university psychiatric hospital and affiliate services were entered in an extensive prospective metabolic study including an oral glucose tolerance test. The prevalence of the metabolic syndrome was assessed based on the National Cholesterol Education Program Adult Treatment Protocol (ATP-III) criteria, the adapted ATP-III criteria using a fasting glucose threshold of 100 mg/dL, and the recently proposed criteria from the International Diabetes Federation (IDF).Results: The analysis of 60 patients showed a prevalence of the metabolic syndrome of 16.7% (ATP-III), 18.3% (adapted ATP-III) and 30.0%) (IDF), respectively. A total of 6.7% of the patients met criteria for diabetes and 23.3% for pre-diabetic abnormalities. Conclusions:The metabolic syndrome and glucose abnormalities are highly prevalent among patients with BD. They represent an important risk for cardiovascular and metabolic disorders. Assessment of the presence and monitoring of metabolic abnormalities and its associated risks should be part of the clinical management of patients with BD. Key words: bipolar disorder -diabetes -metabolic syndrome -physical healthSince the introduction of second-generation antipsychotics and their association with metabolic abnormalities, there has been a rise of interest in the occurrence of metabolic abnormalities in patients treated with these drugs, although the main focus of research was on patients diagnosed with schizophrenia (1-3). The issue of abnormalities in glucose metabolism has received most attention (1, 4-9).Next to diabetes, there has been a surge of interest into other medical conditions such as cardiovascular morbidity, abnormal lipid metabolism and obesity that also have a serious impact on the physical health. In patients with schizophrenia, recent research has demonstrated a prevalence of 40-50% of the metabolic syndrome, which comprises abnormalities in glucose metabolism, lipid metabolism, obesity and blood pressure (10-12).In contrast to patients diagnosed with schizophrenia, research on metabolic abnormalities in patients with bipolar disorder (BD) has been relatively scarce. Three retrospective chart reviews of patients with BD (13-15), one of which also investigated diabetes prevalence in patients with schizoaffective disorder and schizophrenia (15), * MDeH has been a consultant to, received grant /research support and honoraria from, and has served on the speakers/advisory boards of AstraZeneca, Lundbeck JA, Janssen-Cilag, Eli Lilly & Co., Pfizer, Sanofi and Bristol-Myers Squibb. DVE has served on the speakers/advisory board of Sanofi. LH is an employee of Bristol-Myers Squibb. AS has served on the speakers/advisory boards of P...