Erratum to: The prevalence and clinical correlates of metabolic syndrome in patients with schizophrenia: findings from a cohort in Turkey

Most studies point to an increased prevalence of metabolic syndrome (MS) and an increased risk of coronary heart disease (CHD) in schizophrenia patients with MS. The aims of this study were to compare the prevalence of MS in schizophrenia patients with the general population, to explore the clinical correlates and predictors of MS and to evaluate the risk for CHD within 10 years. Consecutive 319 patients, aged 18–75 years, with a diagnosis of schizophrenia according to the DSM-IV were enrolled. The ATP-III, the ATP-IIIA and the IDF criteria were used to define MS. 10-year risk of CHD events was calculated with the Framingham score. One hundred nine (34.2%) patients met the ATP-III criteria, 118 (37%) the ATP-IIIA and 133 (41.7%) the IDF criteria for MS. Patients with MS were older, had a later onset of illness and an older age at first hospitalization. The prevalence of MS in schizophrenia patients was higher from the general population only within the 20–29 age group. Patients with MS had a higher age and sex-corrected 10-year risk of CHD events. The only predictor of MS was the age of illness onset. In conclusion, countries where the general population prevalence of MS is already too high, schizophrenia patients younger than 30 years of age might be under higher risk of morbidity and mortality related with MS. This study points to the necessity for aggressive interventions to correct MS in schizophrenia as early as possible, within the first 10 years of post detection.     

Sex differences in prevalence and clinical correlates of insomnia in Chinese patients with chronic schizophrenia

Objective

It is generally recognized that there are sex differences in many aspects of schizophrenia. The main purpose of this study was to investigate the sex differences in the prevalence and clinical correlates of insomnia in patients with chronic schizophrenia.

Methods

A total of 957 patients who met the DSM-IV diagnostic criteria for schizophrenia were recruited in this cross-sectional study (male/female = 630/327). Demographic, clinical, and insomnia data were collected using self-reported questionnaires. Fasting blood samples were collected to evaluate the status of blood lipids. Psychopathological symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS).

Results

The prevalence rate of insomnia in female patients with schizophrenia was significantly higher than that in male patients (17.3% for males and 26.3% for females; χ² = 10.74, p = 0.001). Regression analysis showed that in male patients, insomnia was independently associated with severe PANSS positive symptoms, severe PANSS depressive factor, and high levels of low-density lipoprotein levels, while in female patients, insomnia was associated with low education level, high PANSS depressive factor, and high levels of apolipoprotein B levels.

Conclusion

This study illustrates that insomnia is more frequent in female than male schizophrenia patients, and that there are differences in the clinical correlates of insomnia by sex, suggesting that sex differences should be considered in prevention and treatment strategies for coexisting insomnia in schizophrenia patients.

     

The prevalence of metabolic syndrome in Korean patients with schizophrenia receiving a monotherapy with aripiprazole, olanzapine or risperidone

Second-generation antipsychotics (SGAs) increase the risk of metabolic syndrome (MetS). Although ethnicity also contributes to MetS risk, the majority of the studies on the relationship of SGAs to this syndrome come from Western countries, whereas few reports have come from Asian countries, especially regarding patients taking a single SGA. We reviewed the electronic medical records of patients with schizophrenia who received aripiprazole, olanzapine or risperidone monotherapies for at least three months. We evaluated the prevalence of MetS in our sample as well as the indirect standardized prevalence ratio (ISPR) using data from the 4th Korean National Health and Nutrition Examination Survey (KNHNES, 2007). The prevalence of MetS in our sample (n = 145) was 31.7%, and the ISPR was 2.09. Male patients had a higher prevalence of MetS than female patients (odds ratio [OR] = 4.18, 95% CI = 1.93-9.03). The ISPR of male patients was 2.67 and statistically significant, whereas the ISPR of female patients was not significant. In our sample, the frequency of abnormal MetS subcomponents occurred in descending order: increased waist circumference, increased triglyceride levels, decreased HDL-cholesterol levels, elevated blood pressure and elevated fasting blood glucose levels. Patients who received aripiprazole were significantly less likely to have MetS. However, a logistic regression showed that age and sex, but not the type of antipsychotic, its dose or the use of antidepressants, were significantly related to the presence of MetS. There were no statistically significant differences among SGAs in terms of MetS subcomponent abnormalities of after adjusting for age and sex. In conclusion, only male Korean patients with schizophrenia who received a monotherapy of aripiprazole, olanzapine or risperidone for more than three months were more likely to have MetS than the general population.     

The metabolic syndrome and schizophrenia: a review

The clinical phenomenon described as the metabolic syndrome has received considerable attention both in the recent medical literature and popular press. Many of the sequelae of events attributable to newer atypical antipsychotics are consistent with the metabolic syndrome definition. This article describes and summarizes the information available on metabolic syndrome in the mental illness disease area and the proposed mechanisms for the increased prevalence of the metabolic syndrome in this population.     

The percentage and clinical correlates of alexithymia in stable patients with schizophrenia

Alexithymia is a common, but less-recognized affective deficit in patients with schizophrenia. To date, no definitive conclusions have been drawn about the relationship between alexithymia and the clinical symptoms or their clinical correlates, particularly in stable patients with schizophrenia. The purpose of this study was to investigate the link between alexithymia and psychopathological symptoms, as well as any associated correlates, in stable patients with schizophrenia. A total of 435 Chinese patients with schizophrenia were recruited. The Positive and Negative Symptoms Scale (PANSS) was used to evaluate each patient’s psychopathological symptoms. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia. The percentage of alexithymia was 35.2% in stable patients with schizophrenia. Compared to non-alexithymia patients, patients with alexithymia had higher PANSS total scores, negative subscores, depressive subscores, and cognitive subscores (all p < 0.05). Multivariate regression analysis revealed that the following variables were positively associated with TAS-20 total scores: PANSS negative subscores (β = 0.274, t = 3.198, p = 0.001) and PANSS depressive subscores (β = 0.366, t = 2.500, p = 0.013). Education years (β = – 0.453, t = – 2.824, p = 0.005) was negatively associated with TAS-20 total scores. Our results suggest that the percentage of alexithymia was relatively higher in stable patients with schizophrenia. Education levels, negative symptoms, and depressive symptoms were independently associated with alexithymia in this specific population.

     

Seclusion and restraint in patients with schizophrenia: clinical and biographical correlates

Seclusion and restraint represent adverse experiences that cause negative attitudes against psychiatric treatment and psychopathologic sequels such as posttraumatic stress disorder. We examined 117 consecutive admissions with schizophrenia, with an average of 8.7 previous admissions. Positive and Negative Syndrome Scale and Global Assessment of Functioning were obtained at admission and discharge, and traumatic events in the biography were recorded using the Posttraumatic Diagnostic Scale. Twenty-four men (42.9%) and 18 women (29.0%) had experienced seclusion or restraint in their psychiatric history. Seclusion or restraint during the present admission was best predicted in a logistic regression model by physical aggressive behavior [odds ratio (OR), 11.5] and the Positive and Negative Syndrome Scale hostility item at admission (OR, 23.6). Seclusion or restraint ever in the psychiatric history, however, was mostly associated with lifetime exposure to life-threatening traumatic events (OR, 7.2). We conclude that exposure to traumatic events in the biography severely enhances the risk of revictimization and retraumatization during inpatient treatment.     

Phenomenological correlates of metabolic activity in 18 patients with chronic schizophrenia

Using [11C]-deoxy-D-glucose and positron emission tomography (PET), the authors measured brain metabolism in 18 patients with chronic schizophrenia to assess which of the metabolic measures from two test conditions was more closely related to the patients' differing clinical characteristics. The two conditions were resting and activation, and an eye tracking task was used. Patients with more negative symptoms showed lower global metabolic rates and more severe hypofrontality than did the patients with fewer negative symptoms. Differences among the patients were distinguished by the task: sicker patients failed to show a metabolic activation response. These findings suggest that cerebral metabolic patterns reflect clinical characteristics of schizophrenic patients.     

Body mass index and prevalence of obesity in a French cohort of patients with schizophrenia

Objective: To evaluate the distributions of body mass index in a large sample of patients with schizophrenia, and to examine the association between body weight and antipsychotic drugs. Method: The data source was baseline data from a national survey conducted in 2005–2006 in 5756 patients. Results: The mean age of the patients was 37.1 ± 11.8 years, and the mean BMI was 25.5 ± 5.2 kg/m². In the final logistic regression model, the prevalence of obesity was significantly higher in female patients, age 40–59 vs. 18–29 years, patients in sheltered employment (vs. no income), out‐patients (vs. full‐time in‐patients) and patients treated with concomitant antidepressant. There was a higher rate of obesity, relative to an absence of antipsychotics at entry, for patients receiving the following individual drugs: clozapine, olanzapine, risperidone and amisulpride. Conclusion: In patients treated with atypical antipsychotics, we found a significantly higher prevalence of obesity than in those not treated with any antipsychotic medication.     

The metabolic syndrome and schizophrenia

Objective: To summarize the accumulated data on metabolic syndrome prevalence in patients with schizophrenia, examine evidence for a biological contribution of the mental illness to metabolic risk and review novel options available for management of prediabetic states. Method: A Medline search using metabolic syndrome, insulin resistance and insulin sensitivity cross‐referenced with schizophrenia was performed on articles published between 1990 and May 2008. Results: Recent evidence indicates that schizophrenia increases predisposition towards metabolic dysfunction independent of environmental exposure. Both fasting and non‐fasting triglycerides have emerged as important indicators of cardiometabolic risk, while metformin, thiazolidinediones and GLP‐1 modulators may prove promising tools for managing insulin resistance. Conclusion: Because of lifestyle, disease and medication effects, schizophrenia patients have significant risk for cardiometabolic disease. Routine monitoring, preferential use of metabolically neutral antipsychotics and lifestyle education are critical to minimizing risk, with a possible role for antidiabetic medications for management of insulin resistant states that do not respond to other treatment strategies.     

Characteristics and clinical correlates of restless legs syndrome in schizophrenia

OBJECTIVE: The cause of restless legs syndrome (RLS) has not yet been ascertained, but one of the most promising theories involves dopaminergic deficiency. In accordance with this theory, we assumed that the prevalence of RLS would be higher among schizophrenics treated with antipsychotics than in the normal population. The purpose of this study was to establish the prevalence, characteristics, and clinical correlates of RLS in schizophrenic patients undergoing treatment with antipsychotics. METHODS: A total of 182 hospitalized schizophrenic patients and 108 age- and sex-matched normal controls were enrolled. The presence of RLS and its severity were assessed using the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria and the IRLSSG rating scale, respectively. The Athens Insomnia Scale (AIS), Brief Psychiatric Rating Scale (BPRS), and Barnes Akathisia Rating Scale (BARS) were used to evaluate insomnia, global psychiatric symptoms, and akathisia, respectively, in schizophrenic patients. RESULTS: Of the 182 schizophrenic patients, 39 (21.4%) were found to have RLS and 87 (47.8%) met at least one of the RLS diagnostic criteria. The prevalence of RLS was significantly higher in the schizophrenia group than in the control group (p=0.009), as were the RLS scores (p<0.001). The BPRS (p=0.001) and the AIS (p<0.001) scores were higher in the RLS group than in the group with no RLS symptoms. CONCLUSION: We conclude that it is important to consider the diagnosis of RLS when schizophrenic patients complain of insomnia, and that RLS symptoms could be associated with more severe psychiatric symptoms and insomnia.     

The prevalence of the metabolic syndrome in patients with schizoaffective disorder--bipolar subtype

OBJECTIVES: To evaluate the point prevalence of the metabolic syndrome in patients with schizoaffective disorder--bipolar type. METHODS: Consenting patients who were participants in an ongoing clinical trial of adjunctive topiramate treatment for schizoaffective disorder, bipolar type were evaluated at baseline for the point prevalence of the metabolic syndrome. The criteria for the metabolic syndrome included: (a) waist circumference > 102 cm (40 inches) in males, or > 88 cm (35 inches) in females; (b) fasting serum triglyceride levels > or = 150 mg/dL; (c) fasting high density lipoproteins (HDL) cholesterol <40 mg/dL in men or <50 mg/dL in women; (d) blood pressure > or = 130/85 mmHg; and (e) fasting glucose > or = 110 mg/dL. Subjects who had at least three of these five criteria were defined as meeting criteria for the metabolic syndrome. RESULTS: Thirty-six subjects (males = 15, females = 21) were evaluated, and three were excluded for missing data. Among those 33 subjects with complete data, 14 subjects (42.4%, males = 7, females = 7, African Americans = 6, Caucasians = 8) met criteria for the metabolic syndrome. Not unexpectedly, those with the metabolic syndrome were significantly more likely to be obese, and have significantly higher mean systolic and diastolic blood pressure, mean fasting triglyceride levels and larger mean waist circumferences, and significantly lower HDL cholesterol levels; and a trend toward higher fasting blood glucose levels. Furthermore, the fasting mean total cholesterol in those with the metabolic syndrome was 217 mg/dL (+/-46). CONCLUSIONS: This preliminary report suggests that the point prevalence of the metabolic syndrome in patients with schizoaffective disorder appears to be higher than that reported in the general population of the USA. Targeted weight reduction and life style change strategies (increased exercise, smoking cessation, stress reduction) may provide useful interventions to decrease the morbidity and mortality that accompanies the presence of the metabolic syndrome in patients with psychiatric illnesses.     

Enlarged cavum septi pellucidi in patients with schizophrenia: clinical and cognitive correlates

Enlarged cavum septi pellucidi (CSP) is a neurodevelopmental anomaly that has been associated with schizophrenia. This study was designed to evaluate, in patients with schizophrenia, the relationship between the severity of this anomaly and measures of symptom and cognitive skills. Three groups were used: patients with large CSP (n=14), patients without large CSP (n=14), and healthy control subjects (n=14). In patients with large CSP, a significant, inverse relationship was found between size of CSP and measures of cognitive deficit. Thus, the greater the size of the anomaly, the greater the cognitive deficit. No relationship was found between severity of CSP and symptom measures.     

住院精神分裂症患者合并代谢综合征的影响因素

目的分析住院精神分裂症患者合并代谢综合征(MS)的影响因素,为精神分裂症合并MS的早期干预提供参考。方法选取在佛山市顺德区伍仲珮纪念医院住院的207例精神分裂症患者为研究对象,均符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准,并根据《中国成人血脂异常防治指南》(2007年) MS诊断标准将患者分为MS组(n=62)和非MS组(n=145)。采用自制调查表收集患者一般资料和抗精神病药物使用情况,并进行腰围、血压、血脂、血糖测定。结果住院精神分裂症患者合并MS的患病率为30. 0%,MS组和非MS组在性别、糖尿病家族史、吸烟史方面比较差异均有统计学意义(P 0. 05或0. 01),Logistic回归分析显示,糖尿病家族史和吸烟史是住院精神分裂症患者合并MS的危险因素(OR=3. 228、2. 689)。结论糖尿病家族史和吸烟史可预测住院精神分裂症患者发生MS的风险。     

社区精神分裂症患者代谢综合征影响因素

背景 精神分裂症患者是罹患代谢综合征的高风险人群。既往关于代谢综合征影响因素的研究主要集中于住院精神分裂症患者,对社区精神分裂症患者的研究较少。目的 探索广州市社区精神分裂症患者不同代谢综合征风险层级的影响因素,为社区精神分裂症患者代谢综合征干预提供参考。方法 于2021年11月,选取广州市精神卫生信息系统在册在管且完成2020年度健康体检的精神分裂症患者3 339例。从信息系统导出患者健康体检资料,采用《中国2型糖尿病防治指南（2020年版）》评估患者是否罹患代谢综合征。根据《精神分裂症患者代谢综合征管理的中国专家共识》,将患者分为高风险组（n=423）、临界组（n=1 524）和代谢综合征组（n=1 392）。采用多元Logistic回归分析社区精神分裂症患者罹患代谢综合征的危险因素。结果 社区精神分裂症患者代谢综合征患病率为41.69%。单因素分析显示,三组在性别（χ²=44.610）、年龄（χ²=55.992）、婚姻状况（χ²=30.755）、病程（χ²=25.913）和体质量指数（χ²=829.265）方面差异均有统计学意义（P均<0.01）。Kruskal-Wallis H检验显示,三组患者腰围（H=920.331）、收缩压（H=436.673）、舒张压（H=393.337）、空腹血糖（H=807.304）、甘油三酯（H=1 134.125）、高密度脂蛋白胆固醇（H=593.615）水平差异均有统计学意义（P均<0.01）。Logistic回归分析显示,年龄≥50岁（OR=1.761,95% CI：1.087~2.853）、超重（OR=2.418,95% CI：1.862~3.140）和肥胖（OR=57.903,95% CI：14.340~233.802）是社区精神分裂症患者成为代谢综合征临界人群的危险因素（P<0.05或0.01）;女性（OR=1.295,95% CI：1.034~1.622）、年龄40~49岁（OR=2.597,95% CI：1.582~4.263）、年龄≥50岁（OR=4.392,95% CI：2.609~7.395）、超重（OR=7.844,95% CI：6.018~10.223）和肥胖（OR=426.785,95% CI：105.724~1 722.839）是社区精神分裂症患者成为代谢综合征人群的危险因素（P<0.05或0.01）。结论 社区精神分裂症患者代谢综合征患病率较高,女性、年长、超重和肥胖是精神分裂症患者罹患代谢综合征的高风险因素。     

Association of metabolic syndrome and inflammation with neurocognition in patients with schizophrenia

The aim of this study is to assess the relationships of metabolic syndrome (MetS) and inflammation with neurocognition in schizophrenia. In this cross-sectional study, we included patients with diagnosis of schizophrenia according to the DSM-IV-TR criteria. We collected socio-demographic information, clinical characteristics, anthropometric measurements, blood tests, and neurocognition measures. A multivariate analysis using multiple linear regressions was performed to determine variables that are potentially associated with neurocognition. The analyses were repeated using MetS as a dichotomised variable (< and ≥3 MetS criteria), a continuous variable (number of MetS criteria present), and for each component of MetS. One hundred and sixty-eight outpatients participated in our study. The prevalence of MetS was 27.4%. An association was found between the number of MetS criteria present and cognitive impairment. Among the different components of MetS, hypertriglycerides and abdominal obesity were the only factors associated with cognitive impairment. Other factors, such as smoking and alcohol dependence or abuse, also revealed a significant relationship, whereas inflammation was not associated with cognitive impairment. In conclusion, our findings suggest that MetS, alcohol use and non-smoking status are associated with cognitive impairment. These findings may support complementary therapeutic approaches in cognitive remediation that lessen the severity of cognitive impairment in schizophrenia.     

The comorbidity of anxiety disorders in bipolar I patients: prevalence and clinical correlates

The purpose of this study was to determine the prevalence of lifetime anxiety disorders in bipolar I patients in Sanliurfa, Turkey, and to assess the association between comorbidity and several demographic and clinical variables. Seventy bipolar I patients in remission were assessed by means of the Structured Clinical Interview for DSM-IV axis I Disorders-Clinician Version (SCID-I-CV), Anxiety Disorder Module in order to detect lifetime comorbid anxiety disorders. Nineteen (27.1%) bipolar I patients were diagnosed with at least one lifetime comorbid anxiety disorder. The most common anxiety disorders in this sample were obsessive compulsive disorder (12.8%) and specific phobia (12.8%), followed by panic disorder (5.7%). Anxiety disorder comorbidity appears to be associated with greater number of hospitalizations, psychotic symptoms and suicide attempts in patients with bipolar I disorder. As comorbidity has a clear impact on the course of bipolar patients, special attention to this issue should be paid when interviewing bipolar patients.     

Substance use in persons with schizophrenia: baseline prevalence and correlates from the NIMH CATIE study

This study examined baseline correlates of substance use in the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness project. Approximately 60% of the sample was found to use substances, including 37% with current evidence of substance use disorders. Users (with and without substance use disorders), compared with nonusers, were significantly more likely to be male, be African-American, have lower educational attainment, have a recent period of homelessness, report more childhood conduct problems, have a history of major depression, have lower negative symptom and higher positive symptom scores on the Positive and Negative Syndrome Scale, and have a recent illness exacerbation. Individuals with comorbid substance use disorders were significantly more likely to be male, report more childhood conduct problems, have higher positive symptom scores on the Positive and Negative Syndrome Scale, and have a recent illness exacerbation. These analyses suggest that substance use disorders in schizophrenia are especially common among men with a history of childhood conduct disorder problems and that childhood conduct disorder problems are potent risk factors for substance use disorders in schizophrenia.