BackgroundPatients with schizophrenia have significantly shorter life expectancy than the general population, and a problem they commonly face is an unhealthy lifestyle, which can lead to obesity and metabolic syndrome. There is a very clear need to determine the prevalence of obesity, hypertension, hyperlipidemia, and diabetes mellitus which are components of metabolic syndrome in patients with schizophrenia, but there has been a paucity of large-scale studies examining this situation in Japan. The aim of our study was to address this need.Setting & ParticipantsWe conducted a large-scale investigation of the prevalence of obesity, hypertension, hyperlipidemia, and diabetes mellitus using a questionnaire in 520 outpatient facilities and 247 inpatient facilities of the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7,655 outpatients and 15,461 inpatients with schizophrenia.ResultsThe outpatients had significantly higher prevalence of obesity, hypertension, hypertriglyceridemia, hyper-LDL cholesterolemia, and diabetes mellitus than the inpatients. The prevalence of hypo-HDL cholesterolemia was higher in inpatients than outpatients. Age-specific analysis showed the prevalence of obesity, hypertension, hypertriglyceridemia, hyper-LDL cholesterolemia, and diabetes mellitus among outpatients to be 2- to 3-fold higher than among inpatients. In individuals aged ≥60 years, the prevalence of obesity and DM among outpatients was about 3-fold higher than among inpatients.ConclusionJapanese outpatients with schizophrenia were more likely to have physical risk such as obesity, hypertension, hyperlipidemia, and diabetes mellitus than inpatients. The physical risk to patients with schizophrenia may be affected by environmental parameters, such as type of care. The physical risk to Japanese patients with schizophrenia demands greater attention.
ObjectivesTo clarify the prevalence of underweight and overweight/obesity, and laboratory data for nutritional status in Japanese outpatients and inpatients with schizophrenia.DesignCross-sectional study.SettingA questionnaire conducted in inpatient and outpatient facilities in Japan.ParticipantsThe population of adult patients with schizophrenia in Japan (N=23 116).Main outcome measuresThe prevalence of underweight and undernutrition in Japanese inpatients and outpatients with schizophrenia.ResultsWe conducted a large-scale investigation of the prevalence of underweight and undernutrition in 520 outpatient facilities and 247 inpatient facilities belonging to the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7655 outpatients and 15 461 inpatients with schizophrenia. There was a significant difference in the distribution of three body mass index levels between outpatients and inpatients (p<0.001). The proportion of underweight inpatients with schizophrenia was significantly higher than that among outpatients (p<0.001). Age-specific analysis revealed that the proportion of underweight individuals aged ≥40 years was higher in inpatients than in outpatients and in the general Japanese population. The proportion of individuals with hypocholesterolaemia was significantly higher in inpatients with schizophrenia than in outpatients (p<0.001). There was a significant difference in the severity of underweight between outpatients and inpatients with schizophrenia; the proportion of severe underweight in inpatients was twofold higher than in outpatients.ConclusionsThe prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia was higher than in outpatients and the general population. Therefore, the physical risk of inpatients should be carefully considered in clinical practice.
BackgroundMetabolic syndrome is a growing concern among patients with schizophrenia because metabolic abnormalities are widely regarded as a major risk factor for cardiovascular disease and premature death. The current study assessed attitudes toward metabolic adverse events among patients with schizophrenia.MethodsA brief questionnaire was constructed to investigate patient recognition of the following broad areas: dietary habits, lifestyle, self-monitoring, knowledge, and medical practice. Between January 2012 and June 2013, questionnaires were sent to patients associated with 520 outpatient facilities and 247 inpatient facilities belonging to the Japan Psychiatric Hospital Association. All of the participants (n=22,072; inpatients =15,170, outpatients =6,902) were diagnosed with schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, or the International Classification of Diseases, tenth revision.ResultsApproximately 55.0% (8,069/14,669) of inpatients and 44.8% of outpatients (2,978/6,649) reported that they did not exercise at all. Although 60.9% (4,116/6,760) of outpatients reported that they felt obese, only 35.6% (5,261/14,794) of inpatients felt obese. More than half of the inpatients (51.2%; 7,514/14,690) and outpatients (60.8%; 4,086/6,721) hoped to receive regular blood tests to prevent weight gain and diseases such as diabetes.ConclusionAlthough more than half of patients hoped to prevent weight gain and diabetes, only a minority of patients were mindful of eating balanced meals and having physical exercise. Educational efforts and the promotion of the best pharmacotherapy and monitoring practices are needed for patients with schizophrenia.
To restore mentally disabled persons to social activities, it is necessary to establish an appropriate facility and support system according to the severity of disorder. In the present study, in an attempt to obtain a guide to identifying conditions on which the use of the support house (engoryou) is effective, patients who had been discharged from the support house were divided into different groups by evaluation at discharge. The first group consisted of 30 patients who underwent continued social rehabilitation (recovery group); the second group consisted of 25 patients with discontinued social rehabilitation (the re-hospitalization group), and their demographic factors were compared. The findings are summarized as follows: (i) the recovery group had a significantly shorter total hospitalization period and a smaller number of hospitalizations before entry into the facility, as compared to the re-hospitalization group; (ii) the recovery group was significantly better than the re-hospitalization group in terms of the score of 'thought disorder', although there was no difference in total Brief Psychiatric Rating Scale (BPRS) score, at the time of entry into the facility; (iii) the recovery group was better than the re-hospitalization group in terms of the Rehabilitation Evaluation Hall and Baker (REHAB) items 'speech skills' and 'self-care' at the time of entry into the facility; (iv) the re-hospitalization group experienced relapse of symptoms, mainly positive ones, at the time of the discontinuation of the use of the facility or re-admission. These findings suggest that to make good use of the support house, the improvement of thought disturbance and self-care must be managed appropriately and the prolongation of hospital stay must be prevented before entry into the facility.
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