Metabolic syndrome and type 2 diabetes in chronic institutionalized patients with schizophrenia

Mamdoh Elgamal¹, Maha Eltayebani², Seham Fathy^3
1 Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt
² Department of Neuropsychiatry Faculty of Medicine, Alexandria University, Alexandria, Egypt
³ Department of Psychiatry Faculty of Medicine, Al Azher University, Girls, Egypt

Correspondence Address:
Mamdoh Elgamal
Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.7123/01.EJP.0000415707.23330.ab

Schizophrenia is a life-threatening illness with a mortality rate that is twice as high as that of the general population. Over 60% of deaths in schizophrenic patients are due to natural causes such as cardiovascular illness. Patients with schizophrenia and schizoaffective or bipolar disorder may have a predisposition to metabolic syndrome that is exacerbated by a sedentary life, poor dietary habits, possible limited access to care, and antipsychotic drug-induced adverse effects. It has been found that the prevalence rate of metabolic syndrome among schizophrenic patients ranges from 32 to 51%, with a two- to three-fold higher mortality rate due to heart attack compared with those without metabolic syndrome.

The current study aimed at detecting the prevalence and patterns of metabolic syndrome in chronic institutionalized patients with schizophrenia, comparing patients with metabolic syndrome - defined by different criteria- and lastly trying to find the predictor factors for metabolic syndrome and for diabetes mellitus.

Ninety-five patients with schizophrenia and schizoaffective disorder were recruited from long-stay hospital wards, were interviewed using structured clinical interview, and were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. They were subjected to a cross-sectional assessment by psychopathological rating scales including positive and negative syndrome scale, mini mental state examination, and clinical global impression – severity index scale and also to anthropometric measurement taking (BMI and waist circumference). Sociodemographic and clinical characteristics as well as treatment history were collected from data files. Cases were classified into four groups according to the International Diabetes Federation criteria: definite cases with metabolic syndrome (IDF criteria); the high-risk group (lacking one criterion); risky cases with risk for central obesity; and patients with no apparent risk. Data were collected and statistically analyzed.

Twenty-two patients (23.15%) had definite metabolic syndrome according to IDF criteria, 47 patients (49.4%) had high risk, 17 patients (17.8%) had risk factors of metabolic syndrome, and only nine cases (9.4%) had no apparent risk for metabolic syndrome. Sociodemographic and clinical characteristics and psychopathological rating scores were not predictors for metabolic syndrome, nor for diabetes mellitus. BMI and waist circumference had the highest sensitivity, predictive value, and diagnostic accuracy for metabolic syndrome compared with the presence of diabetes, hypertension, or dyslipidemia. Diabetes mellitus occurred earlier and was of longer duration compared with other metabolic disturbances.

(1) The high risk of MS among patients with chronic schizophrenia mandates careful monitoring and elimination of risk factors. (2) BMI and WC as well as blood sugar and lipid profile are considered simple measures for detecting risk factors. (3) Attempts towards toward eliminating risk factors such as poor lifestyle, obesity, and metabolic disturbances is vital for long stay hospitalised patients.