Prevention of Metabolic Disease in Schizophrenia Easier Early in Disease

Patients having their first episode of schizophrenia have a significantly lower risk of cardiovascular disease than chronic schizophrenia patients, according to a meta-analysis in the February Schizophrenia Bulletin. The study suggests that clinicians should focus on preventing initial cardiometabolic risk because subsequent reduction in this risk is more difficult to achieve.

Belgian researchers conducted a systematic search of studies looking at cardiometabolic risk in first-episode and chronic patients through December 2011. Twenty six studies examined first-episode patients and 19 included unmedicated patients). For comparison, they identified 78 publications involving chronic patients who were already established on antipsychotic medication. They found that in first-episode and unmedicated patients, all metabolic components and risk factors—diabetes, hyperglycemia, overweight, hypertriglyceridemia, high blood pressure, and smoking—were significantly less common than in those already established on antipsychotic medication. Some of the risk factors, such as waist size, smoking, and blood pressure were significantly lower in unmedicated patients than in first-episode patients who had started medication.

“Some metabolic risk factors...may be present soon after diagnosis but most metabolic complications will take time to develop, offering an important target for prevention,” the researchers said. “Weight gain is a key target that accumulates soon after starting antipsychotic medication. Clinicians should focus on preventing initial cardiometabolic risk because subsequent reduction in this risk is more difficult to achieve, either through behavioral or pharmacologic interventions.”

For more information about metabolic disease and antipsychotic medication, see Psychiatric News here.

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