1. The Metabolic Syndrome in a State Psychiatric Hospital Population Although studies of Metabolic Syndrome (MetS) have been conducted in private and community mental health settings, little research exists on the prevalence of MetS in people with SMI in State psychiatric hospitals. The purpose of this study is to determine the rate of MetS in a State- operated psychiatric hospital population. MetS is a cluster of metabolic risk factors that increase a person’s risk of developing cardiovascular disease and diabetes (National Cholesterol Education Program, 2002 1 ; Ford, 2005 2 ). A diagnosis of MetS is made when three or more of the following criteria are met: Abdominal obesity (Men with a waist circumference >40 in; Women with a waist circumference >35 in) Triglyceride level >150 mg/dL Low HDL cholesterol (Men <40 mg/dL; Women <50 mg/dL) Blood pressure >130/85 mmHg Fasting glucose >110 mg/dL The root causes of MetS are being overweight/obese, physical inactivity, and predisposing genetic factors. It is estimated that 34% of adults in the United States meet the criteria for MetS (Ervin, 2009 3 ). The prevalence of MetS is increased two- to three-fold among people with serious mental illness (SMI) for several reasons (Toalson, 2004 4 ). Antipsychotic medications used to treat people with a variety of psychiatric disorders can cause adverse changes in weight and metabolic parameters associated with type II diabetes and cardiovascular disease. Adults with serious mental illness also are more likely than adults in the general population to have poor health habits. Background  All participants were residents of the Delaware Psychiatric Center (DPC) in New Castle, Delaware.  Calculations of weight and waist circumference were made for each resident.  DPC pharmacy data was used as a proxy to indicate whether the resident was being treated for diabetes, hypertension or hypercholesterolemia.  A resident was given a diagnosis of MetS if he/she had abdominal obesity and was receiving medication for 2 of the 3 qualifying medical conditions. Methods Table 1. Demographics of Participants Results  Twenty-eight (28) out of 202 participants, or 13.9%, qualified for a diagnosis of MetS. These individuals were most likely to be Caucasian and over the age of 61. However, no significant differences in MetS prevalence by demographic or diagnostic groups were found. This prevalence rate was lower than in the general population.  The low rate of MetS in the DPC population may be a result of study inclusion criteria for the pharmacy database, as: 1) residents with shorter lengths of stay were sometimes not started on antihypertensive, hypoglycemic or cholesterol- lowering agents, but were referred for follow-up and medical monitoring in the community; 2) residents with abnormal lab values may have been in the preliminary stages of monitoring for qualifying medical conditions, but not yet receiving the indexed medications; and 3) residents may be receiving non-pharmacologic interventions, such as diet and exercise, to improve medical issues such as hypertension, borderline hyperglycemia and elevated cholesterol.  Policy Implications 1) Exploration of pharmacy data for MetS should be a standard procedure in a residential population; 2) Residents not yet on medication, but with MetS indicators should be examined for potential MetS; and 3) Non- pharmacologic activities such as diet and exercise should be included in prevention efforts for MetS. Discussion Table 2. Presence of Metabolic Syndrome by Demographic Groups Results (cont.) Table 3. Presence of Metabolic Syndrome by Length of Stay at DPC Susanna Kramer, M.A.*, Cynthia Zubritsky, Ph.D.*, Bindu Koshy, M.D.**, Lawrence Markman, M.D.**, Husam Abdallah, M.A.S.**, Margaret Mumaw, B.S.**, Sumedha Chhatre, Ph.D.*, Aileen Rothbard, Sc.D.*, Gerard Gallucci, M.D., M.H.S.**, *** *Center for Mental Health Policy and Services Research, University of Pennsylvania School of Medicine **Delaware Department of Health and Social Services, Division of Substance Abuse and Mental Health ***Johns Hopkins Department of Mental Health and Department of Psychiatry and Behavioral Sciences References National Cholesterol Education Program. (2002). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 106(25), 3143-3421. Ford, E. S. (2005). Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care, 28(7), 1769-1778. Ervin, R. B. (2009). Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. National Health Statistics Report, 13, 1-7. Toalson, P., Ahmed, S., Hardy, T., and Kabinoff, G. (2004). The metabolic syndrome in residents with severe mental illnesses. Primary Care Companion to the Journal of Clinical Psychiatry, 6(4), 152–158.