Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
권호 표지
DOI QR코드

DOI QR Code

Predictors of Metabolic Syndrome in Chronic Schizophrenic Patients Followed for 5 Years(2011-2016)

5년 동안 추적한 만성 조현병 환자에서 대사증후군의 예측인자

  • Joe, Jae-Gil (Department of Psychiatry, Naju National Hospital) ;
  • Yoon, Bo-Hyun (Department of Psychiatry, Naju National Hospital) ;
  • Jeon, Bong-Hee (Department of Psychiatry, Naju National Hospital) ;
  • Park, Su-Hee (Department of Psychiatry, Naju National Hospital) ;
  • Song, Je-Heon (Department of Psychiatry, Naju National Hospital) ;
  • Jeong, Ha-Ran (Department of Psychiatry, Naju National Hospital) ;
  • Hong, Kye Hyun (Department of Psychiatry, Keyo Medical Center)
  • 조재길 (국립나주병원 정신건강의학과) ;
  • 윤보현 (국립나주병원 정신건강의학과) ;
  • 전봉희 (국립나주병원 정신건강의학과) ;
  • 박수희 (국립나주병원 정신건강의학과) ;
  • 송제헌 (국립나주병원 정신건강의학과) ;
  • 정하란 (국립나주병원 정신건강의학과) ;
  • 홍계현 (계요의료재단 계요병원)
  • Received : 2016.10.25
  • Accepted : 2016.11.15
  • Published : 2016.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : To investigate changes in, and predictors of, metabolic syndrome(MetS) status over a 5-year period in chronic schizophrenic patients and to identify factors associated with the prevention of or recovery from MetS. Methods : In total, 107 patients, all of whom provided written informed consent, were followed from 2011 to 2016 at Naju National Hospital for this study. MetS was defined according to the revised National Cholesterol Education Program-Adult Treatment Panel III guidelines. Results : During follow-up period, 22(20.5%) patients were newly diagnosed to MetS, 14(13.1%) were disappeared, 77(66.4%) were not changed[MetS : 34(31.8%), No MetS 37(34.6%)]. Common significant factors in the two changed groups were triglyceride and waist circumference, not dose and type of antipsychotic medication. Multiple logistic regression analysis revealed that female gender(odds ratio[OR]=2.846, 95% confidence interval[CI] : 1.020-7.942), attending two or more outpatient visits per month(OR=3.155, 95% CI : 1.188-8.379) and taking antidepressant medication(OR=3.991, 95% CI : 1.048-15.205) were significantly associated with MetS after controlling for other confounding variables. Type and dose of antipsychotic medication were not significantly associated with MetS. Conclusions : Triglyceride and waist circumference were important manageable indicator of MetS. Adoption of a healthy lifestyle is more important than adjusting the dose or type of antipsychotic medication in the treatment of chronic schizophrenia patients with MetS.

연구목적 본 연구는 대사증후군의 예방과 회복을 위해 5년 동안 추적이 가능한 만성 조현병 환자에서 대사증후군의 변화와 예측인자를 조사하였다. 방 법 2011년부터 2016년까지 추적이 가능하며 동의서에 동의한 107명의 환자가 본 연구에 포함되었다. Revised National Cholesterol Education Program-Adult Treatment Panel III(NCEP-ATP III)를 이용하여 대사증후군을 정의하였다. 결 과 추적 관찰 기간 동안 22명(20.5%)의 환자가 새롭게 대사증후군에 진단되었고 14명(13.1%)는 대사증후군에서 회복되었다. 77명(66.4%)은 변화가 없었다(대사증후군이 있는 환자:34명[31.8%], 대사증후군이 없는 환자 : 37명[34.6%]). 복부둘레와 중성 지방이 대사증후군의 유무가 변화된 환자들에서 중요한 인자였다. 다른 변수를 통제한 다변량 회귀분석에서 여성(OR=2.846, 95% C.I. 1.020-7.942), 1달에 1회 이상 외래 방문(OR=3.155, 95% C.I. 1.188-8.379), 항우울제 병합치료(OR=3.991, 95% C.I. 1.048-15.205)가 대사증후군의 유병률에 유의한 영향을 주었다. 반면에 항정신병 약물의 종류나 용량은 대사증후군의 유병률에 영향을 주지 못했다. 결 론 만성 조현병 환자에서 약제의 변경 및 용량조절보다 증상에서의 회복과 건강한 생활 습관이 대사증후군에 중요하다.

Keywords

References

  1. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: Is the differential mortality gap worsening over time? Arch Gen Psychiatry 2007;64:1123-1131. https://doi.org/10.1001/archpsyc.64.10.1123
  2. Lambert TJ, Velakoulis D, Pantelis C. Medical comorbidity in schizophrenia. Med J Aust 2003;178:67-70.
  3. Laursen TM. Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophr Res 2011;131:101-104. https://doi.org/10.1016/j.schres.2011.06.008
  4. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-689. https://doi.org/10.2337/diacare.24.4.683
  5. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991;14:173-194.
  6. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Fernando Costa. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-2752. https://doi.org/10.1161/CIRCULATIONAHA.105.169404
  7. Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders-A systematic review and meta-analysis. Schizophr Bull 2013;39:306-318. https://doi.org/10.1093/schbul/sbr148
  8. Nam YY, Kim CS, Ahn CW, Park KM, Ryu B, Kim CH. Clinical Correlates of Metabolic Syndrome in Patients with Chronic Schizophrenia. Korean J Psychopharmacol 2006;17:335-341.
  9. Lee HY, Choi JE. Prevalence of the Metabolic Syndrome among Outpatients with Schizophrenia or Schizoaffective Disorder. Korean J Schizophr Res 2012;15:39-45. https://doi.org/10.16946/kjsr.2012.15.1.39
  10. Kang KD, Sea YH, Yoon BH. Prevalence of metabolic syndrome in chronic schizophrenic inpatients. J Korean Soc Biol Psychiatry 2012;18:281-289.
  11. McCreadie R, Macdonald E, Blacklock C, Tilak-Singh D, Wiles D, Halliday J, Paterson J. Dietary intake of schizophrenic patients in Nithsdale, Scotland: case-control study. BMJ 1998;317:784-785. https://doi.org/10.1136/bmj.317.7161.784
  12. Vancampfort D, Probst M, Scheewe T, De Herdt A, Sweers K, Knapen J, van Winkel R, De Hert M. Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia. Psychiatry Res 2013;207:25-32. https://doi.org/10.1016/j.psychres.2012.09.026
  13. Sicras-Mainar A, Maurino J, Ruiz-Beato E, Navarro-Artieda R. Prevalence of metabolic syndrome according to the presence of negative symptoms in patients with schizophrenia. Neuropsychiatr Dis Treat 2014;11:51-57.
  14. Haupt DW. Differential metabolic effects of antipsychotic treatments. Eur Neuropsychopharmacol 2006;16:149-155. https://doi.org/10.1016/j.euroneuro.2006.06.003
  15. Krakowski M, Czobor P, Citrome L. Weight gain, metabolic parameters, and the impact of race in aggressive inpatients randomized to double-blind clozapine, olanzapine or haloperidol. Schizophr Res 2009;110:95-102. https://doi.org/10.1016/j.schres.2009.02.006
  16. Riordan HJ, Antonini P, Murphy MF. Atypical Antipsychotics and Metabolic Syndrome in Patients with Schizophrenia; Risk Factors, Monitoring, and Healthcare Implications. Am Health Drug Benefits 2011;4:292-302.
  17. American Diabetes Association/American Psychiatric Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004;27:596-601. https://doi.org/10.2337/diacare.27.2.596
  18. Lin CC, Bai YM, Wang YC, Chen TT, Lai IC, Chen JY, Gau SS, Liou YJ. Improved body weight and metabolic outcomes in overweight or obese psychiatric patients switched to amisulpride from other atypical antipsychotics. J Clin Psychopharmacol 2009;29:529-536. https://doi.org/10.1097/JCP.0b013e3181bf613e
  19. Morrato EH, Newcomer JW, Kamat S, Baser O, Harnett J, Cuffel B. Metabolic screening after the American Diabetes Association's consensus statement on antipsychotic drugs and diabetes. Diabetes Care 2009;32:1037-1042. https://doi.org/10.2337/dc08-1720
  20. Emsley R. Chiliza B, Asmal L, Harvey BH. The nature of relapse in schizophrenia. BMC Psychiatry 2013;13:50-57. https://doi.org/10.1186/1471-244X-13-50
  21. Hert MD, Schreurs V, Vancampfort D, Winkel RV. Metabolic syndrome in people with schizophrenia:a review. World Psychiatry 2009:8:15-22. https://doi.org/10.1002/j.2051-5545.2009.tb00199.x
  22. WHO[homepage on the Internet]. Oslo: WHO ATC/DDD index 2016. [updated 2015 DEC 16; cited 2016 SEP 4]. Available from: http://www.whocc.no/atc_ddd_index.
  23. Inada T, Inagaki A. Psychotropic dose equivalence in Japan. Psychiatry Clin Neurosci 2015;69:440-447. https://doi.org/10.1111/pcn.12275
  24. Stahl SM, Mignon L, Meyer JM. Which comes first: atypical antipsychotic treatment or cardiometabolic risk? Acta Psychiatr Scand 2009;119:171-179. https://doi.org/10.1111/j.1600-0447.2008.01334.x
  25. Hert MD, Schreurs V, Sweers K, Van Eyck D, Hanssens L, Sinko S, Wampers M, Scheen A, Peuskens J, van Winkel R. Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in firstepisode patients with schizophrenia: A retrospective chart review. Schizophr Res 2008;101:295-303. https://doi.org/10.1016/j.schres.2008.01.028
  26. Schorr SG, Slooff CJ, Bruggeman R, Taxis K. The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year. J Psychiatr Res 2009;43:1106-1111. https://doi.org/10.1016/j.jpsychires.2009.03.002
  27. Park EO, Su Choi SJ, Lee HY. The Prevalence of Metabolic Syndrome and Related Risk Factors Based on the KNHANES V 2010. J Agric Med Community Health 2013;38:1-13. https://doi.org/10.5393/JAMCH.2013.38.1.001
  28. Arango C, Bobes J, Aranda P, Carmena R, Garcia-Garcia M, Rejas J. CLAMORS Study Collaborative Group. A comparison of schizophrenia outpatients treated with antipsychotics with and without metabolic syndrome: Findings from the CLAMORS study. Schizophr Res 2008;104:1-12. https://doi.org/10.1016/j.schres.2008.05.009
  29. Almeras N, Despres JP, Villeneuve J, Demers MF, Roy MA, Cadrin C, Mottard JP, Bouchard RH. Development of an atherogenic metabolic risk profile associated with the use of atypical antipsychotics. J Clin Psychiatry 2004;65:557-564. https://doi.org/10.4088/JCP.v65n0417
  30. Boke O, Aker S, Sarisoy G, Saricicek EB, Sahin AR. Prevalence of metabolic syndrome among inpatients with schizophrenia. Int J Psychiatry Med 2008;38:103-112. https://doi.org/10.2190/PM.38.1.j
  31. Lieberman JA. Pathophysiologic mechanisms in the pathogenesis and clinical course of schizophrenia. J Clin Psychiatry 1999;60:9-12. https://doi.org/10.4088/JCP.v60n0104
  32. Papanastasiou E. Interventions for the metabolic syndrome in schizophrenia: a review. Ther Adv Endocrinol Metab 2012;3:141-162. https://doi.org/10.1177/2042018812458697
  33. Mao YM, Zhang MD. Augmentation with antidepressants in schizophrenia treatment: benefit or risk. Neuropsychiatr Dis Treat 2015;11:701-713.
  34. Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J 2005;150:1115-1121. https://doi.org/10.1016/j.ahj.2005.02.007
  35. Gabriele JM, Dubbert PM, Reeves RR. Efficacy of behavioural interventions in managing atypical antipsychotic weight gain. Obes Rev 2009;10:442-455. https://doi.org/10.1111/j.1467-789X.2009.00570.x
  36. Son MA, Lee YM, Jung KA. The effects of a combined exercise program on obesity and metabolic syndrome factors for chronic psychiatric inpatients. J Korean Biol Nurs Sci 2014;16:105-112. https://doi.org/10.7586/jkbns.2014.16.2.105
  37. Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, Gheorghe MD, Rybakowski JK, Galderisi S, Libiger J, Hummer M, Dollfus S, Lopez-Ibor JJ, Hranov LG, Gaebel W, Peuskens J, Lindefors N, Riecher-Rossler A, Grobbee DE. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371:1085-1097. https://doi.org/10.1016/S0140-6736(08)60486-9
  38. McEvoy JP, Lieberman JA, Perkins DO, Hamer RM, Gu H, Lazarus A, Sweitzer D, Olexy C, Weiden P, Strakowski SD. Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind 52-week comparison. Am J Psychiatry 2007;164:1050-1060. https://doi.org/10.1176/ajp.2007.164.7.1050
  39. Patel JK, Buckley PF, Woolson S, Hamer RM, McEvoy JP, Perkins DO, , Lieberman JA. Metabolic profiles of second-generation antipsychotics in early psychosis: findings from the CAFE study. Schizophr Res 2009;111:9-16. https://doi.org/10.1016/j.schres.2009.03.025
  40. Meyer JM, Davis VG, Goff DC, McEvoy JP, Nasrallah HA, Davis SM, Rosenheck RA, Daumit GL, Hsiao J, Swartz MS, Stroup TS, Lieberman JA. Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia trial: prospective data from phase 1. Schizophr Res 2008;101:273-286. https://doi.org/10.1016/j.schres.2007.12.487
  41. Grover S, Aggarwal M, Dutt A, Chakrabarti S, Avasthi A, Kulhara P, Somaiya M, Malhotra N, Chauhan N. Prevalence of metabolic syndrome in patients with schizophrenia in India. Psychiatry Res 2012;200:1035-1037. https://doi.org/10.1016/j.psychres.2012.03.043
  42. Gordon PC, Xavier JC, Louza MR. Weight gain, metabolic disturbances, and physical health care in a Brazilian sample of outpatients with schizophrenia. Neuropsychiatr Dis Treat 2013;9:133-138.
  43. Yazici MK, Anil Yaocioolu AE, Ertuorul A, Eni N, Karahan S, Karaaoaoolu E, Tokgozoglu SL. The prevalence and clinical correlates of metabolic syndrome in patients with schizophrenia: Findings from a cohort in Turkey. Eur Arch Psychiatry Clin Neurosci 2011;261:69-78. https://doi.org/10.1007/s00406-010-0118-x
  44. Pramyothin P, Khaodhiar L. Metabolic syndrome with the atypical antipsychotics. Curr Opin Endocrinol Diabetes Obes 2010;17:460-466. https://doi.org/10.1097/MED.0b013e32833de61c