Lead Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust; and Reader, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, UK.
Professor in Medical Statistics and Statistical Learning, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
Br J Psychiatry. 2019 Dec;215(6):712-719. doi: 10.1192/bjp.2019.159.
The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.
We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.
This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.
Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).
Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
精神病首次发作是出现心血管代谢风险的关键时期。
我们旨在探讨个体和生活方式因素对早期精神病患者心血管代谢结局的影响。
这是一项针对 293 名英国成年人首发精神病的前瞻性队列研究，调查了社会人口统计学、生活方式（体力活动、久坐行为、营养、吸烟、饮酒、物质使用）和药物对接下来 12 个月内心血管代谢结局的影响。
肥胖和血糖调节异常的发生率分别从基线时的 17.8%和 12%上升到 1 年后的 23.7%和 23.7%。在 76.8%的吸烟率或每天久坐超过 10 小时的四分之一人群中，随着时间的推移，这些数据几乎没有变化。我们没有发现基线生活方式或所开抗精神病药物类型与基线或 1 年时的心血管代谢结果之间存在任何关联。来自少数族裔（BME）群体的参与者的平均血红蛋白 A1c（HbA1c）增加了 3.3 mmol/mol，而白种人则几乎没有变化。在 12 个月时，三分之一有 BME 背景的人超过了糖尿病前期的阈值（HbA1c >39 mmol/mol）。
不健康的生活方式选择在早期精神病中很普遍，而且心血管代谢风险在接下来的一年中恶化，这为预防提供了一个重要的窗口。然而，我们没有证据表明，预防策略应该优先根据生活习惯来制定。需要进一步研究以确定是否应该允许针对不同种族人群出现心血管代谢风险的不同模式制定临床策略。
