Garcia-Rizo Clemente, Kirkpatrick Brian, Fernandez-Egea Emilio, Oliveira Cristina, Bernardo Miquel
Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine, Reno, NV, USA.
Psychoneuroendocrinology. 2016 May;67:70-5. doi: 10.1016/j.psyneuen.2016.02.001. Epub 2016 Feb 12.
Patients with serious mental illnesses exhibit a reduced lifespan compared with the general population, a finding that can not solely rely on high suicide risk, low access to medical care and unhealthy lifestyle. The main causes of death are medical related pathologies such as type 2 diabetes mellitus and cardiovascular disease; however pharmacological treatment might play a role.
We compared a two hour glucose load in naïve patients at the onset of a serious mental illness (N=102) (84 patients with a first episode of schizophrenia and related disorders, 6 with a first episode of bipolar I disorder and 12 with a first episode of major depression disorder) with another psychiatric diagnose, adjustment disorder (N=17) and matched controls (N=98).
Young patients with serious mental illness showed an increased two hour glucose load compared with adjustment disorder and the control group. Mean two hour glucose values [±standard deviation] were: for schizophrenia and related disorders 106.51mg/dL [±32.0], for bipolar disorder 118.33mg/dL [±34.3], for major depressive disorder 107.42mg/dL [±34.5], for adjustment disorder 79.06mg/dL[±24.4] and for the control group 82.11mg/dL [±23.3] (p<0.001).
Our results reflect an abnormal metabolic pathway at the onset of the disease before any pharmacological treatment or other confounding factors might have taken place. Our results suggest a similar glycemic pathway in serious mental illnesses and the subsequent need of primary and secondary prevention strategies.
与普通人群相比，严重精神疾病患者的寿命缩短，这一发现不能仅仅归因于高自杀风险、医疗服务可及性低和不健康的生活方式。主要死因是与医学相关的病理状况，如2型糖尿病和心血管疾病；然而，药物治疗可能也起了一定作用。
我们比较了初发严重精神疾病患者（N = 102）（84例首次发作的精神分裂症及相关障碍患者、6例首次发作的双相I型障碍患者和12例首次发作的重度抑郁症患者）、另一种精神科诊断（适应障碍，N = 17）以及匹配对照组（N = 98）在两小时葡萄糖负荷试验中的情况。
与适应障碍组和对照组相比，初发严重精神疾病的年轻患者两小时葡萄糖负荷增加。两小时葡萄糖均值[±标准差]分别为：精神分裂症及相关障碍组106.51mg/dL [±32.0]，双相障碍组118.33mg/dL [±34.3]，重度抑郁症组107.42mg/dL [±34.5]，适应障碍组79.06mg/dL[±24.4]，对照组82.11mg/dL [±23.3]（p<0.001）。
我们的结果反映了在任何药物治疗或其他混杂因素出现之前，疾病发作时代谢途径就已异常。我们的结果表明，严重精神疾病存在相似的血糖代谢途径，因此随后需要采取一级和二级预防策略。
