Presented by Hilary Shone Metabolic syndrome in psychiatrically hospitalized patients treated with antipsychotics and other psychotropics Franca Centorrino, Grace A. Masters, Alessandra Talamo, Ross J. Baldessarini and Dost Ongur Presented by Hilary Shone September 9, 2014

Outline/Objectives Background Results Strengths/weaknesses Ideas for further research Applicability in dietetics practice

Background Severely disordered psychiatric patients at increased risk for co- morbidity compared to general population Long-term antipsychotic treatment linked with conditions of metabolic syndrome Prevalence of metabolic syndrome 14% greater in patients treated with antipsychotics than general population (37% vs. 23%) Previous studies have broached the topic, more details needed

Purpose/Research Questions Direct purpose of research not made clear Close ‘remaining gaps in relevant details’ Between the lines Factors such as number of antipsychotics or psychotropic meds Prevalence of metabolic syndrome among different diagnoses Length of antipsychotic treatment What factors can affect the prevalence of metabolic syndrome in the psychotropic-treated severely mentally ill population?

Study Design 589 inpatients, ages > 18, at McLean Hospital Followed medical record data from March 1, 2010-March 31, 2011 Types of data recorded Total chlorpromazine-equivalent (CPZ-eq) mg/day Metabolic syndrome evaluated using National Cholesterol Education Program guidelines

Results Schizoaffective consistently highest Characteristic All patients Bipolar Schizoaffective Schizophrenia Other psychoses Cases (n [%]) 589 (100) 173 (29.4) 108 (18.3) 76 (12.9) 74 (12.6) Ages (years) Onset 24.7 + 9.50 24.7 + 10.3 23.6 + 8.30 22.9 + 6.70 25.6 + 8.90 First treated 25.8 + 9.60 26.6 + 10.7 23.6 + 7.60 23.4 + 6.60 26.5 + 9.20 Current 35.7 + 13.0 34.9 + 13.6 40.8 + 11.8 37.3 + 13.0 31.5 + 12.1 Years ill 8.40 + 10.3 6.80 + 9.10 15.8 + 10.4 11.1 + 11.6 4.20 + 7.90 CPZ-equivalent antipsychotic dose (mg/day) 182 + 298 130 + 220 386 + 375 361 + 426 86.7 + 172 BMI (kg/m²) Mean + SD 28.0 + 6.7 28.0 + 6.9 30.5 + 7.5 28.4 + 5.7 25.3 + 5.9 Prior antipsychotics 29.1 + 6.7 29.4 + 7.0 30.8 + 7.5 29.0 + 5.7 27.7 + 6.40 No prior antipsychotics 25.3+ 5.8 24.2 + 5.0 25.1 + 6.1 24.2 + 3.5 22.7 + 3.90 Overweight (%) 26.1 28.3 22.2 28.9 27.0 Obese (%) 31.1 44.4 30.3 20.3 Metabolic Syndrome (%) All subjects 23.7 39.8 18.4 18.9 29.5 30.2 40.6 20.9 31.6 7.20 4.50 0.00 5.60 Schizoaffective consistently highest Relationship between CPZ-equivalent and metabolic syndrome

Results Antipsychotic exposure Polytherapy Increased risk of metabolic syndrome Metabolic syndrome and CPZ-eq total daily doses Use of 2 > antipsychotics 3.4 times greater CPZ-eq dose than single antipsychotic use Prevalence of being overweight or obese (body mass index ≥25 kg/m2; shaded bars) and of metabolic syndrome (striped bars) versus years of treatment in 589 hospitalized patients. Both relationships were highly significant (χ2 = 35.2 and 39.2, both p < 0.0001), and these outcome measures were strongly correlated (r = 0.967 p = 0.007)

Strengths Limitations Large sample size Consideration of polytherapy & effects on risk/prevalence Length of exposure to treatment Categorization by diagnoses, practical use Short time frame of study Signs of metabolic syndrome prior to antipsychotic use Time of metabolic syndrome diagnosis Unsure of dietary habits

Further research Applicability in Dietetics Practice Examine and include diets of patients at time of study Review and/or conduct interventions, consider results Mechanism of drug action-true causative factor of weight gain Applicability in Dietetics Practice Awareness of adverse side effects of antipsychotics Early intervention through nutrition education and counseling Manage side effect(s) of increased appetite and weight gain Continue monitoring and counseling as necessary

References Centorrino, F., Masters, G. A., Talamo, A., Baldessarini, R. J. and Öngür, D. (2012), Metabolic syndrome in psychiatrically hospitalized patients treated with antipsychotics and other psychotropics. Hum. Psychopharmacol. Clin. Exp., 27: 521–526. doi: 10.1002/hup.2257