Şizofreni ve Metabolik Sendrom: İzlem Çalışması

Abstract

Metabolic syndrome (MetS) plays a role in decreased survival rate of schizophrenia patients when compared to the general population. The prevalance of MetS in schizophrenia patients increases in Turkey and the world. High prevalence of MetS in the schizophrenic population is associated with antipsychotic drugs, genetic, psychotic process and lifestyle. The prevalence of MetS in schizophrenia patients was studied in our department between 2004 and 2007, and 10 year risk of coronary heart disease (CHD) was calculated. The aim of this study is to evaluate the current MetS prevalance, change in MetS prevalance and related prognostic factors in the original sample and to compare the current CHD prevalence with the previously estimated 10-year risk. The study was conducted at Hacettepe University Faculty of Medicine, Department of Psychiatry. Three hundred nineteen patients with schizophrenia or schizoaffective disorder who had been included in the first study were recruited. Physical measurements and laboratory tests indicative of metabolic parameters were performed. Patients were evaluated with Positive and Negative Syndrome Scale (PANSS), UKU side effects scale, International Physical Activity Questionnaire (IPAQ), 24 hour dietary recall method and Nutrition Information Systems Package Program (BEBIS, version 6.1). Difference between the groups were analysed with chi square and Mann Whitney U test. Univariate variance analysis and Kruskal Wallis test were used when comparing two or more independent groups. The significance of the change in MetS prevalances was investigated with McNemar test. One hundred and forty nine patients were evaluated, 19 patients refused to paticipate in the study, 18 patients were determined to be deceased, and remaining 133 patients could not be reached. According to ATPIII, ATPIIIA, and IDF criteria MetS prevalances of 44.3%, 53%, 55.7%, respectively, were determined cross-sectionally. Shorter period of psychiatric instutionalization, higher UKU total side effects score, higher daily consumption of sugar, cholesterol, and polyunsaturated fatty acids (PUFA) were found patients with MetS. According to the ATPIII, ATPIIIA, and IDF criteria MetS prevalences increased from 35.6% to 44.3%, 38.9% to 53%, 43.6% to 55.7%, respectively, through the 8 year follow-up. Higher daily consumption of sugar and PUFA were determined among recently diagnosed MetS patients. Overall mortality ratio was calculated as 9.67%. Coronary heart disease related mortality ratio was 33.33% and increased up to 72.22% when unknown cause of death ratio was added. In conclusion MetS prevalance was found to be increased among schizophrenia patients through the time. Our study implies no association between the increase in MetS prevalance and sociodemographic/clinical characteristics, severity of psycopathology, and antipsychotic therapy. It could be suggested that causal factors such as nutrition status which are unrelated to clinical features and psychiatric treatment play a role in this increased prevalance MetS. The majority of deaths in schizophrenia patients was found to be due to CHDs.