Nearly 40 percent of patients admitted to an inpatient unit with psychotic
or mood disorders were found to have metabolic syndrome—a constellation
of signs and symptoms that, taken together, are an intermediate step in the
development of type II diabetes, cardiovascular disease, and ultimately a
significantly elevated risk of early death.
The finding comes from a new report by Richard Bermudes, M.D., now an
assistant clinical professor of psychiatry at the University of California,
Davis, and colleagues in the December 2006, Psychosomatics. The
research was completed without outside funding while Bermudes was a junior
attending at the University of Cincinnati Medical Center.
Bermudes and his coauthors noted that the widespread and growing use of
second-generation antipsychotics (SGAs) for off-label indications and patient
populations has been well documented over the last five to seven years.
Numerous peer-reviewed reports have also detailed the propensity of as many as
30 percent of patients taking the medications to experience a gain of more
than 10 percent of their baseline weight after beginning treatment with an
In addition, SGAs have been associated with elevations of serum
triglycerides, cholesterol, and abnormalities in glucose metabolism, all of
which are signals of impending metabolic syndrome. Other research, Bermudes
added, indicated that patients with severe psychiatric disorders have elevated
rates of cardiovascular disease and diabetes.
Therefore, Bermudes and his colleagues hypothesized that a group of
patients with primary psychotic and mood disorders who are taking SGAs would
be at especially high risk of having metabolic syndrome.
They studied 102 adult patients with a primary diagnosis of a mood or
psychotic disorder admitted to the inpatient psychiatry service at the
University of Cincinnati Medical Center from November 2003 through March 2004.
The researchers retrospectively collected data on height, weight, clinical
laboratory findings (including fasting triglyceride, HDL cholesterol, and
glucose levels), and blood pressure.
Metabolic syndrome was defined using the following diagnostic guidelines in
the Third Report of the National Cholesterol Education Program Adult Treatment
Panel (ATP III):
In accordance with the ATP III guidelines, patients in the study were said
to have metabolic syndrome if three of the five criteria were present.
Overall, 38.6 percent of the group of severely ill psychiatric inpatients
met criteria for metabolic syndrome. Bermudes noted that the Third National
Health and Nutrition Examination Survey (NHANES III), which collected patient
data from 1988 through 1994, estimated the rate of metabolic syndrome in the
general population to be about 21 percent.
In the cohort of patients studied by Bermudes and colleagues, those with
metabolic syndrome were significantly older (average age 44 compared with 35
for those without metabolic syndrome), had larger waist circumferences (46.3
inches compared with 38.4 inches), and larger body mass indices (34.9 versus
27). Metabolic syndrome was also associated with Caucasian ethnicity and
"Our study indicated that more than 2 in 3 mentally ill patients had
the metabolic syndrome and therefore harbored what is usually a clinically
silent and unidentified elevated risk for cardiovascular disease and type II
diabetes," Bermudes and his colleagues said.
"Psychiatrists should consider measuring [blood pressure] and waist
circumference, two components of the metabolic syndrome, which are easily
assessed in the office setting," they suggested. In this sample,
patients who had elevated blood pressure and large waist circumference met
criteria for the full metabolic syndrome 86 percent of the time.
"All patients taking atypical antipsychotics require monitoring of
weight, fasting glucose, and lipids," the researchers concluded."
Failure to monitor metabolic parameters and intervene early may result
in continued high rates of morbidity in severely mentally ill patients
secondary to complications of [cardiovascular disease] and
Because the root causes of metabolic syndrome for a majority of individuals
with chronic mental illness may be poor diet, insufficient physical activity,
and side effects from medications, "the high prevalence of the syndrome
underscores an urgent need to develop comprehensive efforts directed at
controlling the obesity epidemic and improving physical activity levels within
the population of chronic mentally ill patients."
"The Prevalence of the Metabolic Syndrome in Psychiatric
Inpatients With Primary Psychotic and Mood Disorders" is posted at<www.psy.psychiatryonline.org/cgi/content/abstract/47/6/491>.▪