1. 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

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

3. 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

4. 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?

5. 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

6. 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
First treated
Current
Years ill
CPZ-equivalent antipsychotic dose (mg/day)
BMI (kg/m²)
Mean + SD
Prior antipsychotics
No prior antipsychotics
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

7. 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)

8. 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

9. 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

10. 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:  /hup.2257