患有重度精神疾病的年轻女性认知障碍的代谢风险因素。
Metabolic risk factors of cognitive impairment in young women with major psychiatric disorder.
作者信息
Zhuo Chuanjun, Liu Wei, Jiang Ronghuan, Li Ranli, Yu Haiping, Chen Guangdong, Shan Jianmin, Zhu Jingjing, Cai Ziyao, Lin Chongguang, Cheng Langlang, Xu Yong, Liu Sha, Luo Qinghua, Jin Shili, Liu Chuanxin, Chen Jiayue, Wang Lina, Yang Lei, Zhang Qiuyu, Li Qianchen, Tian Hongjun, Song Xueqin
机构信息
Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China.
Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Front Psychiatry. 2022 Jul 29;13:880031. doi: 10.3389/fpsyt.2022.880031. eCollection 2022.
BACKGROUND
Cognitive performance improves clinical outcomes of patients with major psychiatric disorder (MPD), but is impaired by hyperglycemia. Psychotropic agents often induce metabolism syndrome (MetS). The identification of modifiable metabolic risk factors of cognitive impairment may enable targeted improvements of patient care.
OBJECTIVE
To investigate the relationship between MetS and cognitive impairment in young women with MPD, and to explore risk factors.
METHODS
We retrospectively studied women of 18-34 years of age receiving psychotropic medications for first-onset schizophrenia (SCH), bipolar disorder (BP), or major depressive disorder (MDD). Data were obtained at four time points: presentation but before psychotropic medication; 4-8 and 8-12 weeks of psychotropic therapy; and enrollment. MATRICS Consensus Cognitive Battery, (MCCB)-based Global Deficit Scores were used to assess cognitive impairment. Multiple logistic analysis was used to calculate risk factors. Multivariate models were used to investigate factors associated with cognitive impairment.
RESULTS
We evaluated 2,864 participants. Cognitive impairment was observed in 61.94% of study participants, and was most prevalent among patients with BP (69.38%). HbA1c within the 8-12 week-treatment interval was the most significant risk factor and highest in BP. Factors in SCH included pre-treatment waist circumference and elevated triglycerides during the 8-12 weeks treatment interval. Cumulative dosages of antipsychotics, antidepressants, and valproate were associated with cognitive impairment in all MPD subgroups, although lithium demonstrated a protect effect (all < 0.001).
CONCLUSIONS
Cognitive impairment was associated with elevated HbA1c and cumulative medication dosages. Pre-treatment waist circumference and triglyceride level at 8-12 weeks were risk factors in SCH. Monitoring these indices may inform treatment revisions to improve clinical outcomes.
背景
认知功能可改善重度精神障碍（MPD）患者的临床结局，但会受到高血糖的损害。精神药物常常诱发代谢综合征（MetS）。识别认知障碍的可改变代谢风险因素可能有助于针对性地改善患者护理。
目的
研究患有MPD的年轻女性中MetS与认知障碍之间的关系，并探索风险因素。
方法
我们回顾性研究了年龄在18 - 34岁之间，因首次发作的精神分裂症（SCH）、双相情感障碍（BP）或重度抑郁症（MDD）而接受精神药物治疗的女性。数据在四个时间点获取：就诊时但在服用精神药物之前；精神药物治疗4 - 8周和8 - 12周时；以及入组时。基于MATRICS共识认知成套测验（MCCB）的总体缺陷评分用于评估认知障碍。采用多元逻辑分析计算风险因素。使用多变量模型研究与认知障碍相关的因素。
结果
我们评估了2864名参与者。61.94%的研究参与者存在认知障碍，在BP患者中最为普遍（69.38%）。8 - 12周治疗间隔内的糖化血红蛋白（HbA1c）是最显著的风险因素，在BP患者中最高。SCH患者的风险因素包括治疗前腰围以及8 - 12周治疗间隔内甘油三酯升高。在所有MPD亚组中，抗精神病药物、抗抑郁药物和丙戊酸盐的累积剂量均与认知障碍相关，尽管锂具有保护作用（均P < 0.001）。
结论
认知障碍与HbA1c升高和累积药物剂量相关。治疗前腰围和8 - 12周时的甘油三酯水平是SCH的风险因素。监测这些指标可能有助于调整治疗方案以改善临床结局。
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