New York University School of Medicine, Department of Psychiatry, New York, NY, United States.
New York University, Division of General Internal Medicine and Clinical Innovation, New York, NY, United States; Veterans Affairs New York Harbor Healthcare System, New York, NY, United States.
J Psychiatr Res. 2018 Apr;99:159-166. doi: 10.1016/j.jpsychires.2018.01.005. Epub 2018 Feb 2.
There is limited research on metabolic abnormalities in psychotropic-naïve patients with serious mental illness (SMI). Our study examined metabolic conditions in a large, ethnically diverse sample of psychotropic-naïve and non-naïve adults with SMI at an urban public hospital.
In this cross-sectional study of 923 subjects, the prevalences of hyperglycemia meeting criteria for type 2 diabetes mellitus (T2DM) based on fasting plasma glucose and obesity defined by BMI and abdominal girth were compared across duration of psychotropic medication exposure. Multiple logistic regression models used hyperglycemia and obesity as dependent variables and age, sex, race/ethnicity, and years on psychotropics as independent variables.
Psychotropic-naïve patients, including both schizophrenia and non-psychotic subgroups, showed an elevated prevalence of hyperglycemia meeting criteria for T2DM and a decreased prevalence of obesity compared to the general population. Obesity rates significantly increased for those on psychotropic medications more than 5 years, particularly for patients without psychosis (BMI: aOR = 5.23 CI = 1.44-19.07; abdominal girth: aOR = 6.40 CI = 1.98-20.69). Women had a significantly higher obesity rate than men (BMI: aOR = 1.63 CI = 1.17-2.28; abdominal girth: aOR = 3.86 CI = 2.75-5.44). Asians had twice the prevalence of hyperglycemia as whites (aOR = 2.29 CI = 1.43-3.67), despite having significantly less obesity (BMI: aOR = .39 CI = .20-.76; abdominal girth: aOR = .34 CI = .20-.60). Hispanics had a higher rate of obesity by BMI than whites (aOR = 1.91 CI = 1.22-2.99).
This study showed disparities between obesity and T2DM in psychotropic-naïve patients with SMI, suggesting separate risk pathways for these two metabolic conditions.
在精神疾病严重的未经精神药物治疗的患者中，代谢异常的研究有限。我们的研究在一家城市公立医院，对大量、种族多样化的未经精神药物治疗和经精神药物治疗的精神疾病严重患者的代谢状况进行了检查。
在这项 923 例患者的横断面研究中，根据空腹血糖将符合 2 型糖尿病（T2DM）标准的高血糖患病率和 BMI 和腰围定义的肥胖患病率与精神药物暴露时间进行了比较。多因素逻辑回归模型将高血糖和肥胖作为因变量，年龄、性别、种族/民族和使用精神药物的年限作为自变量。
未经精神药物治疗的患者，包括精神分裂症和非精神病亚组，与一般人群相比，符合 T2DM 标准的高血糖患病率较高，肥胖患病率较低。服用精神药物超过 5 年的患者肥胖率显著增加，尤其是没有精神病的患者（BMI：aOR=5.23 CI=1.44-19.07；腰围：aOR=6.40 CI=1.98-20.69）。女性肥胖率显著高于男性（BMI：aOR=1.63 CI=1.17-2.28；腰围：aOR=3.86 CI=2.75-5.44）。尽管亚洲人的肥胖患病率明显较低（BMI：aOR=0.39 CI=0.20-0.76；腰围：aOR=0.34 CI=0.20-0.60），但高血糖的患病率是白种人的两倍（aOR=2.29 CI=1.43-3.67）。与白种人相比，西班牙裔的 BMI 肥胖率更高（aOR=1.91 CI=1.22-2.99）。
这项研究表明，精神疾病严重的未经精神药物治疗的患者中，肥胖症和 T2DM 之间存在差异，这表明这两种代谢状况存在不同的风险途径。
