It has long been recognized that certain metabolic conditions are associated with cardiovascular disease and increased risk for morbidity and mortality.1,2 These alterations in metabolic functions often occur in clusters, a presentation known as metabolic syndrome.3,4 There is ongoing debate about how best to conceptualize and define metabolic syndrome, but most authorities now accept that central obesity or visceral adiposity, altered glucose and lipid metabolism, and hypertension are critical health indicators.4-6
Although most studies have focused on the risk of metabolic syndrome for patients with schizophrenia exposed to atypical antipsychotics, other psychiatric patients appear to be at risk for metabolic disturbances as well.7-9 Major depressive disorder (MDD) may be of particular interest because it is much more common than schizophrenia and is treated with a broad range of psychotropics.
In a recent study presented at the 160th Annual Meeting of the American Psychiatric Association, we examined the prevalence of metabolic syndrome and each of the 5 criteria for this syndrome (Table 1) in psychiatric inpatients aged 18 through 64 years with a clinical diagnosis of MDD (N = 912).10 These findings were compared with data from a similar sample of patients who had schizophrenia (N = 255). Table 2 presents demographic data. A total of 30.3% (n = 296) of the MDD sample had psychotic features, and 19.2% (n = 175) had recurrent depression. Alcohol or other substance abuse/dependence was comorbid in 57.3% of the patients with MDD and in 39.6% of the patients with schizophrenia. Table 3 lists the psychotropics that were being prescribed at index admission.
The investigators found that in the MDD sample, 22% of patients met the Adult Treatment Panel (ATP) III criteria for metabolic syndrome and that at least 1 of the 5 criteria for the syndrome was present in 75% of the patients.10 The Figure shows the proportion of the MDD patients who met each ATP criterion compared with patients who had schizophrenia and with the general population.10,11 There was no difference in the prevalence of metabolic syndrome in the 2 patient groups nor in the proportion of patients who had at least 1 of the 5 criteria, but these rates were much higher than in the general population.
Patients in the MDD and schizophrenia samples were statistically different only on the fasting blood glucose criterion (14.9% vs 26.9%, respectively; x2 = 18.67; P < .001); there was a trend toward a greater prevalence of elevated triglycerides in MDD patients (32.7% vs 24.5%; x2 = 3.76; P = .053).
1. Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288: 2709-2716.
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3. National Institutes of Health. Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive summary. http://www.nhlbi.nih.gov/guidelines/ cholesterol/atp3xsum.pdf. Published May 2001. Accessed November 19, 2008.
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11. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). Nation-al Health and Nutrition Examination Survey Data. Updated September 11, 2008. http://www.cdc.gov/nchs /nhanes.htm. Accessed November 19, 2008.
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15. Kinder LS, Carnethon MR, Palaniappan LP, et al. Depression and the metabolic syndrome in young adults: findings from the Third National Health and Nutrition Examination Survey. Psychosom Med. 2004; 66:316-322.