Objective: The aim of this prospective naturalistic follow-up study is to investigate the factors related to the development or reversal of metabolic syndrome in patients suffering schizophrenia and/or schizoaffective disorder.
Method: Our sample constituted of 240 patients with schizophrenia or schizoaffective disorder (according to the DSM-IV criteria) at the onset, whereas 195 patients were evaluated at the follow-up visit after six months. The blood levels of fasting glucose, triglyceride, High Density Lipoprotein (HDL) cholesterol, insulin and, blood pressure, waist circumference, body weight, body mass index, HOMA index and physical activity level were evaluated. This study was supported by Pamukkale University Scientific Research Committee (project No: 2008 TPF 029).
Results: It was found that 94 patients (48.20%) had MetS and 100 (51.80%) patients were free of MetS at the follow-up visit. Out of 94 patients, 69 patients (73.4%) had MetS at the baseline whereas 25 patients (26.6%) developed MetS during follow-up period. The means of baseline weight, BMI, waist circumference, triglyceride and insulin levels, blood pressure and HOMA index of the patients with recently developed MetS were significantly higher compared to the patients free of MetS at both visit (n:84). The first group had also significantly lower HDL levels than the second group at the baseline. We found that overweight patients (BMI>25) and the patients who met the individual MetS criteria for blood pressure and HDL levels and treated with depot antipsychotics have higher risk for MetS development (odss ratios; 38.878, 15.547, 4,285 and 3.277, respectively). Seventeen patients (19.80%), who had MetS previously did not met MetS criteria at the end of sixth months. Reversal rate was found to be 16.83% (17/101). Mean weight, BMI, waist circumference, fasting glucose and insulin level, HOMA index and the change of total physical activity scores of reversed MetS (n:17) group at baseline were significantly different from those suffering MetS at both visit. No increase of physical inactivity level and the presence of insulin resistance were related to significantly lower chance for reversal of MetS. (odds ratios; 21.042, 8.229, respectively). We did not find any relationship between the type of antipsychotic treatment and reversal of MetS (p>0.05).
Conclusion: Our study has suggested that overweight patients treated with injectable antipsychotic medications should be closely monitorized for metabolic parameters. Our results also have indicated the importance of physical activity and insulin resistance to deal with metabolic syndrome in schizophrenia patients. Reversal of MetS is an important issue in continuous antipsychotic treatment and factors associated with reversal and development of MetS should be investigated in more detail.