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Metabolic risks in psychosis in Sweden

Metabolic risks in psychosis in Sweden. Urban Ösby MD, PhD, Senior Consultant Psykiatri Nordöst, Stockholm County Council Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. urban.osby@sll.se. Declaration of interest: Urban Ösby. Grant support:

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Metabolic risks in psychosis in Sweden

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  1. Metabolic risks in psychosis in Sweden Urban Ösby MD, PhD, Senior Consultant Psykiatri Nordöst, Stockholm County Council Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden urban.osby@sll.se

  2. Declaration of interest: Urban Ösby Grant support: Stockholm County Council, NARSAD, Bristol-Myers Squibb Advisory Board/Consultant: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Pfizer Speakers Bureau: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Pfizer

  3. Prevalence of Diagnosed Diabetes in General Population Versus Schizophrenic Population Percent of population Schizophrenic: General: 50-59 y 60-74 y 75+ y Harris et al. Diabetes Care. 1998; 21:518. Mukherjee et al. Compr Psychiatry. 1996; 37(1):68-73.

  4. Mental Disorders and Smoking • Higher prevalence (56-88% for patients with schizophrenia) of cigarette smoking (overall U.S. prevalence 25%) • More toxic exposure for patients who smoke (more cigarettes, larger portion consumed) • Smoking is associated with increased insulin resistance • Similar prevalence in bipolar disorder George TP et al. Nicotine and tobacco use in schizophrenia. In: Meyer JM, Nasrallah HA, eds. Medical Illness and Schizophrenia. American Psychiatric Publishing, Inc. 2003; Ziedonis D, Williams JM, Smelson D. Am J Med Sci. 2003(Oct);326(4):223-330

  5. Overview- THE PROBLEM • Increased Morbidity and Mortality Associated with Serious Mental Illness (SMI) • Increased Morbidity and Mortality Largely Due to Preventable Medical Conditions • Metabolic Disorders, Cardiovascular Disease, Diabetes Mellitus • High Prevalence of Modifiable Risk Factors (Obesity, Smoking) • Epidemics within Epidemics (e.g., Diabetes, Obesity) • Some Psychiatric Medications Contribute to Risk • Established Monitoring and Treatment Guidelines to Lower Risk Are Underutilized in SMI Populations

  6. What are the Causes of Morbidity and Mortality in People with Serious Mental Illness? • While suicide and injury account for about 30-40% of excess mortality, about 60% of premature deaths in persons with schizophrenia are due to “natural causes” • Cardiovascular disease • Diabetes • Respiratory diseases • Infectious diseases

  7. Goals: Lower Risk for CVD • Blood cholesterol • 10%  = 30%  in CHD (200-180) • High blood pressure (> 140 SBP or 90 DBP) • 4-6 mm Hg  = 16%  in CHD; 42%  in stroke • Cigarette smoking cessation • 50%-70%  in CHD • Maintenance of ideal body weight (BMI = 25) • 35%-55%  in CHD • Maintenance of active lifestyle (20-min walk daily) • 35%-55%  in CHD Hennekens CH. Circulation. 1998;97:1095-1102.

  8. Identification of the Metabolic Syndrome HDL = high-density lipoprotein. NCEP III. Circulation. 2002;106:3143-3421.

  9. Schizophrenia: Natural Causes of Death • Higher standardized mortality rates than the general population from: • Diabetes 2.7x • Cardiovascular disease 2.3x • Respiratory disease 3.2x • Infectious diseases 3.4x • Cardiovascular disease associated with the largest number of deaths • 2.3 X the largest cause of death in the general population Osby U et al. Schizophr Res. 2000;45:21-28.

  10. Swedish study of metabolic risks in psychosis • Population-based recruitment from psychosis outpatient departments • Prospective design with 3 years follow-up. Drug-naive patients included separately. • Assessments: 1) Diagnosis, social function (GAF+CGI), present and previous medication; 2) Weight, waist circumference, BMI, BP; 3) Somatic health: DM, cardiovascular disease, smoking, alcohol use etc. Lab: 1) clinical: Hb, glucose, lipids, TSH, etc; 2) research: serum + plasma + blood for DNA

  11. Metabolic risks 1. Metabolic adverse effects of antipsychotic, mood stabilizing and anti-depressant medication – weight gain, DM, lipid disturbances, etc 2. Life style factors related to the disease – increased smoking, increased alcohol use, less exercise, etc 3. Overlapping risk genes between psychiatric and metabolic disorders?

  12. Psychiatric diagnosis (n=615) Diagnosis: N % M/F Age Schizophrenia 328 53 57/43 46.6 Other psychosis 187 30 44/56 45.9 Other diagnoses 100 16 45/55 48.5 Controls 5580 41/59 56.1

  13. Psychiatric history • SZ PS Other Age at start of treatment 28 31 31 Months in hospital 15 8 7 GAF 50 53 58 Use of antipsychotics ,% 96 91 63

  14. * P<0,05, ** P<0.01, *** P<0,001, ns: not significant

  15. * P<0,05, ** P<0.01, *** P<0,001, ns: not significant

  16. ns ns ns *** ns ns * P<0,05, ** P<0.01, *** P<0,001, ns:not significant

  17. * P<0,05, ** P<0.01, *** P<0,001, ns: not significant

  18. Smoking

  19. Snuff

  20. Metabolic syndrome according to IDF criteria

  21. Lipids

  22. General health

  23. Heredity for metabolic disorders, % • SZ PS Other Ctrl Cardiac disorder 48 47 51 Elevated BP 49 55 54 DM 25 22 26 48 Obesity 30 28 34

  24. Present antipsychotic drugs (n=615) Olanzapine 124 20,2 % Risperidone 111 18.0 % Aripiprazol 72 11.7 % Perfenazin 69 11.2 % Haloperiodol 58 9.4 % Zuclopentixol 56 9.1 % Clozapine 52 8.5 % Quetiapine 32 5.2 % Flupentixol 21 3.4 % Other/ND 30 4.9 %

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