Metabolic Syndrome: Differences between Psychiatric and Internal Medicine Patients

Margari, Francesco; Lozupone, Madia; Pisani, R.; Pastore, Adriana; Todarello, Orlando; Zagaria, Giuseppina; Minerva, Francesco; Palasciano, Giuseppe; Palmieri, Vincenzo O.

doi:10.2190/pm.45.3.a

Cited by 14 publications

(21 citation statements)

References 69 publications

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“…In this study, the population group most frequently sampled were hospital inpatients ( k = 38), and only three of the included studies were conducted in a community health setting (one utilizing CBT and two utilizing MI). Previous research has observed differences in anthropometric, biochemical, and cardiovascular risk profiles between inpatients and outpatients ( 40 ). As such, generalizability of these findings to the community health setting is limited.…”

Section: Discussionmentioning

confidence: 98%

Psychological Interventions for the Management of Glycemic and Psychological Outcomes of Type 2 Diabetes Mellitus in China: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

Chapman

Liu

Merkouris

et al. 2015

Front. Public Health

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IntroductionChina has the largest number of type 2 diabetes mellitus (T2DM) cases globally, and T2DM management has become a critical public health issue in China. Individuals with T2DM have an increased risk of developing mental health disorders, psychological disturbances, and functional problems associated with living with their condition. Previous systematic reviews have demonstrated that, generally, psychological interventions are effective in the management of T2DM-related outcomes; however, these reviews have predominantly included studies conducted within English-speaking countries and have not determined the efficacy of the varying types of psychological interventions. As such, this paper aims to synthesize evidence and quantify the efficacy of psychological therapies for the management of glycemic and psychological outcomes of T2DM in China, relative to control conditions.MethodsA systematic search (MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wangfang Data) for all years to December 2014 identified all available literature. Eligibility criteria included: peer-reviewed journal articles, randomized controlled trials (RCTs) assessing the efficacy of a psychological therapy for the management of T2DM, adult participants (≥18 years) diagnosed with T2DM or non-insulin-dependent diabetes mellitus, and Chinese speaking participants only (in mainland China). Outcome measures were glycated hemoglobin, blood glucose concentration, depression, anxiety, and quality of life. Effect sizes were pooled using a random effects model. Negative effect sizes corresponded to positive outcomes favoring the intervention.ResultsForty-five RCTs were eligible for the meta-analyses. Cognitive behavioral therapy (CBT) and motivational interviewing (MI) were more effective than the control condition in the reduction of glycated hemoglobin [CBT: −0.97 (95% CI −1.37 to −0.57); MI: −0.71 (95% CI −1.00 to −0.43)]. CBT and client-centered therapy (CCT) were also associated with reductions in depression and blood glucose concentration, and CBT was associated with reductions in anxiety.ConclusionPsychological interventions, namely, CBT, MI, and CCT are effective in improving certain T2DM-related outcomes in China. Considerable levels of heterogeneity and unclear risk of bias associated with most included RCTs suggest caution when interpreting results. In China, where the burden of T2DM is increasing significantly, psychological interventions may provide promising approaches to assist in the management of T2DM to delay the progression of T2DM related outcomes.

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Section: Discussionmentioning

confidence: 98%

Psychological Interventions for the Management of Glycemic and Psychological Outcomes of Type 2 Diabetes Mellitus in China: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

Chapman

Liu

Merkouris

et al. 2015

Front. Public Health

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“…[1][2][3][4]7,8 As a matter of fact, this profile, along with abnormal WC and insulin levels, accounts for most of the metabolic differences observed between psychiatric and internal medicine patients. 26 Total and LDL-c levels are not formally included in the MS criteria and are often unreported, but they are among the strongest predictors of atherosclerosis and cardiovascular diseases. 27 In a context different from BD, a negative correlation between blood cholesterol levels and impulsive, violent, and suicidal behaviors has been extensively explored, with conflicting results.…”

Section: Metabolic Profilementioning

confidence: 99%

Metabolic syndrome and related variables, insulin resistance, leptin levels, and PPAR-γ2 and leptin gene polymorphisms in a pedigree of subjects with bipolar disorder

Baptista¹,

Sandia²,

Fernández

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: Evidence points to a high prevalence of metabolic dysfunction in bipolar disorder (BD), but few studies have evaluated the relatives of subjects with BD. We conducted a cross-sectional study in an extended family of patients with BD type I. Methods: The available relatives of the same family were interviewed (DSM-IV-R) and assessed in fasting conditions for body mass index, constituent variables of the metabolic syndrome (MS), leptin levels, insulin resistance index, and single nucleotide polymorphisms (SNPs) for the leptin receptor and promoter and PPAR-c2 genes. The frequency of MS was compared with that recorded in the local general population. Results: Ninety-three relatives of three adults with BD were evaluated (30 aged , 18 years, 63 aged . 18 years). The frequency of MS was similar to that of the general population. Significantly higher frequencies of abnormal glucose, total and low density cholesterol (LDL-c) levels (all p , 0.05), waist circumference (p = 0.057), and leptin and insulin resistance values (in adults only) were observed in the family. Adults with the QQ genotype of the leptin receptor displayed higher LDL-c levels than carriers of the R allele. Conclusions: The associations among BD consanguinity, familial hypercholesterolemia, and leptin receptor SNPs reported herein should be replicated and extended in other pedigrees.

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“…Three studies included only patients with schizophrenia and controls: two studies were based on FRS (CVD) scores: 10.7 vs. 8.5 p ≤ 0.01 [ 28 ] and 4.7 (4.7) vs. 3.1 (3.2), p = 0.002 [ 29 ] and one was based on FRS (CHD) scores: 8.6 (7.3) vs. 6.3 (6.0), p < 0.001 [ 24 ]. Two studies included psychiatric diagnoses and were based on FRS (CVD) scores: 11.3 (12.3) vs. 6.8 (6.4), p < 0.01 [ 25 ] and 8.3 (5.8) vs. 10.7 (5.9), p = 0.05 [ 26 ]. One study included depressive disorders: 10.3 (7.6) vs. 10.1 (7.7), p = 0.97 [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

“… Jin H, 2011 [ 56 ] FRS (CHD) was increased by 79 % in schizophrenia, 72 % in posttraumatic stress disorder and 61 % in mood disorder. Mackin P, 2007 [ 25 ] 11.3 (12.3) 1.7 (3.2) 9.3 (10.5) Margari F, 2013 [ 26 ] 8.3 (5.8) Correll CU, 2011 [ 47 ] 2.5 (4.2) Taylor V, 2010 [ 64 ] FRS (CHD) was lower for patients at baseline and follow-up, but increased across the follow-up period (2-years). Women patients showed an increase risk for CHD over time, and men did not.…”

Section: Resultsmentioning

confidence: 99%

Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis

et al. 2016

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BackgroundCardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population.MethodsMEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95 % confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality.ResultsA total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7 %), depressive disorders (14.7 %), SMI (11.4 %) and bipolar disorders (8.6 %). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively).Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95 % CI:−0.02 to 0.71], p = 0.06); high heterogeneity was observed (I2 = 93 %; p < 0.001).ConclusionsThe summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population.The systematic review is registered in PROSPERO: CRD42013003898.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0833-6) contains supplementary material, which is available to authorized users.

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Metabolic Syndrome: Differences between Psychiatric and Internal Medicine Patients

Abstract: Specific features of MetS in psychiatric population are mainly represented by young age of onset, hyperinsulinemia, increased abdominal adiposity, and low HDL cholesterol whose common denominator may be insulin-resistance.

Cited by 14 publications

References 69 publications

Psychological Interventions for the Management of Glycemic and Psychological Outcomes of Type 2 Diabetes Mellitus in China: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

Psychological Interventions for the Management of Glycemic and Psychological Outcomes of Type 2 Diabetes Mellitus in China: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

Metabolic syndrome and related variables, insulin resistance, leptin levels, and PPAR-γ2 and leptin gene polymorphisms in a pedigree of subjects with bipolar disorder

Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis

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