Metabolic syndrome in antipsychotic-naïve patients with first-episode psychosis: a systematic review and meta-analysis

Abstract

Background It is unclear what the prevalence of metabolic syndrome (MetS) in drug-naïve first-episode of psychosis (FEP) is, as previous meta-analyses were conducted in minimally exposed or drug-naïve FEP patients with psychotic disorder at any stage of the disease; thus, a meta-analysis examining MetS in naïve FEP compared with the general population is needed. Methods Studies on individuals with FEP defined as drug-naïve (0 days exposure to antipsychotics) were included to conduct a systematic review. A meta-analysis of proportions for the prevalence of MetS in antipsychotic-naïve patients was performed. Prevalence estimates and 95% CI were calculated using a random-effect model. Subgroup analyses and meta-regressions to identify sources and the amount of heterogeneity were also conducted. Results The search yielded 4143 articles. After the removal of duplicates, 2473 abstracts and titles were screened. At the full-text stage, 112 were screened, 18 articles were included in a systematic review and 13 articles in the main statistical analysis. The prevalence of MetS in naïve (0 days) FEP is 13.2% (95% CI 8.7–19.0). Ethnicity accounted for 3% of the heterogeneity between studies, and diagnostic criteria used for MetS accounted for 7%. When compared with controls matched by sex and age, the odds ratio is 2.52 (95% CI 1.29–5.07; p = 0.007). Conclusions Our findings of increased rates of MetS in naïve FEP patients suggest that we are underestimating cardiovascular risk in this population, especially in those of non-Caucasian origin. Our findings support that altered metabolic parameters in FEPs are not exclusively due to antipsychotic treatments.

Pattern of long-term weight and metabolic changes after a first episode of psychosis: Results from a 10-year prospective follow-up of the PAFIP program for early intervention in psychosis cohort

“…DUP has been widely associated with a greater severity of psychotic symptoms at presentation [ 50 ] and to poorer outcomes of psychosis [ 51 ], and long DUP correlates with long duration of prodromal symptoms and with poorer social support and functioning [ 52 ]. In this sense, a long DUP could indirectly determine difficulties in self-care and in the access to professional care, which could ultimately lead to poorer physical health conditions, such as metabolic syndrome [ 53 ] or glucose intolerance [ 31 ], described at baseline in drug-naïve FEP patients. However, this increased risk of metabolic alterations in drug-naïve FEP patients could not be attributed to the DUP [ 54 ].…”

Risk factors for metabolic syndrome in individuals with recent-onset psychosis at disease onset and after 1-year follow-up

“…The increased rates of MetS recently reported in antipsychotic naïve FEP patients 3 compared to those reported in HCs clearly suggest that there is an urgent need to investigate risk factors that contribute to MetS parameters that would allow preventive health strategies. With this aim, we investigated risk factors associated with MetS at the onset of psychotic disorders.…”

“…The prevalence of MetS in young adults is approximately 5–7%, with low HDL-c being the most prevalent MetS component (41.2%), followed by elevated blood pressure (26.6%) and abdominal obesity (23.6%) 2 . An increased prevalence of MetS of 13.2% has been recently identified in antipsychotic-naïve patients with first-episode psychosis (FEP) 3 . Similarly, blood pressure, waist circumference and fasting glucose have been reported to be slightly higher in antipsychotic-naïve subjects with a high risk of psychosis than in the general population 4 , and low HDL-c has been reported in drug-naïve adolescents with FEP 5 .…”

The psychosis metabolic risk calculator (PsyMetRiC) for young people with psychosis: International external validation and site-specific recalibration in two independent European samples

“…Large-scale meta-analyses confirm a globally high prevalence of MetS in young people with psychosis, 18 and those trends translate into strong global associations with CVD. 19 Therefore, there is an international need for new strategies to address the physical comorbidity of psychotic disorders.…”