Cardiometabolic Risk in First Episode Psychosis Patients

Abstract

Previous research in patients with schizophrenia in European and USA population groups has demonstrated a high prevalence of metabolic syndrome and disease progression (~35%–40%) and increased risk for cardiovascular disease and long-term mortality. Limited research has determined the prevalence of existing cardiometabolic risk factors at onset of a first episode psychosis. This cross-sectional study presents a clinical overview of the cardiometabolic risk profile in young people with first episode psychosis in the UK. Forty-six participants (72% male) clinically diagnosed with first episode psychosis (n = 25), schizophrenia (n = 13), bipolar disorder (n = 4), unspecified non-organic psychosis (n = 2) or acute psychotic episode (n = 2) with < 6 months Duration of Untreated Psychosis (DUP; mean 33.4 ± 37.2 days) were assessed for anthropometric, health risk behaviors and clinical measurements including resting heart rate, blood pressure, blood lipids, glycated hemoglobin, and prolactin. Overall, participants (aged 18–37 years) had a high prevalence of cardiometabolic risk factors due to: elevated values for BMI (73%) and abdominal adiposity (50%), blood pressure (47% prehypertensive; 23% hypertensive), resting heart rate (43%); hypercholesterolemia (32%); suboptimal HDL-C levels (36%); and hypertriglyceridemia (40%). Participants also self-reported poor health risk habits including smoking (55%), alcohol use (39%), substance use (18%), poor diet (52%), and sedentary behavior (29%). Young people with psychosis are at increased risk for cardiometabolic disorders due to elevated clinical markers and health risk behaviors. Physical health interventions (including health behavior advice) are needed early in the treatment process to address this increased risk for cardiometabolic disorders in individuals recently diagnosed with psychosis.

Early Lipid Metabolic Effects of the Anti-Psychotic Drug Olanzapine on Weight Gain and the Associated Gene Expression

“…Incidence of the metabolic syndrome has received increased attention in patients with schizophrenia as metabolic abnormalities are major risk factors for cardiovascular disease and mortality. 1 , 23 Although the causes of metabolic abnormalities among patients with schizophrenia are complicated, the risk factors are attributed to lifestyle habits, long duration of disease and treatment, and negative symptoms. 1 , 24 , 25 Additionally, metabolic syndrome is highly prevalent in patients with schizophrenia who are taking atypical antipsychotics.…”

Crosstalk between Schizophrenia and Metabolic Syndrome: The Role of Oxytocinergic Dysfunction

“…The prevalence of metabolic syndrome in antipsychotic-naïve persons with first-episode psychosis is 13.2% worldwide, a 2.52-fold risk for metabolic syndrome over the age-and gender-matched general population [108]. Persons with schizophrenia demonstrate several hallmark features of metabolic syndrome conditions that increase cardiometabolic risk [109,110]. Several studies have reported that drug-naïve persons with first-episode psychosis have significantly higher body mass indexes and abdominal adiposity, increased fasting glucose levels, increased fasting insulin and insulin resistance, and higher total cholesterol and triglyceride concentrations compared with their healthy controls [47,[110][111][112][113][114][115].…”

“…Persons with schizophrenia demonstrate several hallmark features of metabolic syndrome conditions that increase cardiometabolic risk [109,110]. Several studies have reported that drug-naïve persons with first-episode psychosis have significantly higher body mass indexes and abdominal adiposity, increased fasting glucose levels, increased fasting insulin and insulin resistance, and higher total cholesterol and triglyceride concentrations compared with their healthy controls [47,[110][111][112][113][114][115]. More specifically, the potential intrinsic link between insulin resistance and impaired glucose tolerance with first-episode psychosis might help to explain the increased prevalence of metabolic syndrome in persons with schizophrenia beyond that with medication, lifestyle, or accessibility of health care [19].…”

Inflammation subtypes in psychosis and their relationships with genetic risk for psychiatric and cardiometabolic disorders

“…Cardiometabolic diseases, including coronary heart disease, obesity, diabetes, and dyslipidemia, are highly prevalent in persons with psychotic disorders and have been associated with poor cognitive and functional outcomes and reduced life expectancy in this population ( DE HERT et al., 2009 ; Saha et al., 2007 ; Perry et al., 2019 ; Hagi et al., 2021 ). Excess cardiometabolic risks are commonly attributed to side effects from antipsychotic drugs used to treat these illnesses, unhealthy lifestyle, poor access or engagement with healthcare, or other socioeconomic factors ( Correll et al., 2014 , Smith et al., 2020 ). However, these risks have also been reported in antipsychotic-naïve patients with first-episode psychosis ( Correll et al., 2014 ; Perry et al., 2016 ; Garcia-Rizo et al., 2017 ) and their first-degree relatives ( Fernandez-Egea et al., 2008 ), suggesting a genetic etiology independent of treatment effects.…”