Heald Adrian, Daly Chris, Warner-Levy John Julian, Williams Richard, Meehan Cheyenne, Livingston Mark, Pillinger Toby, Hussain Lamiece, Firth Joseph
The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester, UK.
Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, M6 8HD, UK.
Ann Gen Psychiatry. 2024 Jan 3;23(1):1. doi: 10.1186/s12991-023-00485-8.
Weight gain in the months/years after diagnosis/treatment of severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased risk of cardiometabolic diseases. There is limited data on the longer-term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a retrospective study on weight change over the 5 years following an SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on comparing non-affective psychosis (NAP) vs affective psychosis (AP) diagnoses.
We undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) or affective psychosis (AP). We analysed body mass index (BMI) change in the 5-year period following the first prescription of antipsychotic medication. All individuals had taken an antipsychotic agent for at least 3 months. The 5-year follow-up point was anywhere between 2003 and 2023.
We identified 9125 people with the diagnoses above. NAP (n = 5618; 37.3% female) mean age 49.9 years; AP (n = 4131; 60.5% female) mean age 48.7 years. 27.0% of NAP were of non-White ethnicity vs 17.8% of AP individuals. A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for AP. There were no significant differences in baseline BMI profile. In a subsample with HbA1c data (n = 2103), mean HbA1c was higher in NAP at baseline (40.4 mmol/mol in NAP vs 36.7 mmol/mol for AP). At 5-year follow-up, there was similarity in both the overall % of individuals in the obese ≥ 30 kg/m category (39.8% NAP vs 39.7% AP), and % progressing from a normal healthy BMI transitioned to obese/overweight BMI (53.6% of NAP vs 55.6% with AP). 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7% with AP. At 5-year follow-up for NAP, 83.1% of those with BMI ≥ 30 kg/m stayed in this category vs 81.5% of AP.
The results of this real-world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, while 43% maintain a healthy weight in the first 5 years following antipsychotic prescription.
在严重持久性精神疾病（SMI）诊断/治疗后的数月/数年中体重增加是未来患糖尿病、代谢异常以及心血管代谢疾病风险增加的主要预测因素。关于有SMI病史者体重变化的长期情况以及个体间差异的数据有限。我们在此报告一项对英国大曼彻斯特地区（一个种族和文化多元的社区）SMI诊断后5年体重变化的回顾性研究，特别关注比较非情感性精神病（NAP）与情感性精神病（AP）的诊断情况。
我们在大曼彻斯特护理记录（GMCR）中进行了匿名搜索。我们查阅了首次被诊断为首发精神病、精神分裂症、分裂情感性障碍、妄想性障碍（非情感性精神病=NAP）或情感性精神病（AP）的任何人的健康记录。我们分析了抗精神病药物首次处方后5年内的体重指数（BMI）变化。所有个体服用抗精神病药物至少3个月。5年随访时间点在2003年至2023年之间。
我们确定了9125名有上述诊断的人。NAP（n = 5618；37.3%为女性），平均年龄49.9岁；AP（n = 4131；60.5%为女性），平均年龄48.7岁。27.0%的NAP为非白人种族，而AP个体中这一比例为17.8%。被诊断为NAP的人群中处于社会劣势最高五分位的比例更高，分别为52.4%和39.5%。基线BMI情况无显著差异。在有糖化血红蛋白（HbA1c）数据的子样本（n = 2103）中，NAP的基线平均HbA1c更高（NAP为40.4 mmol/mol，AP为36.7 mmol/mol）。在5年随访时，肥胖（BMI≥30 kg/m²）个体的总体百分比相似（NAP为39.8%，AP为39.7%），以及从正常健康BMI转变为肥胖/超重BMI的百分比也相似（NAP为53.6%，AP为55.6%）。BMI正常的NAP中有43.7%保持健康BMI，AP中这一比例为42.7%。在NAP的5年随访中，BMI≥30 kg/m²的人群中有83.1%仍处于这一类别，AP中这一比例为81.5%。
这项真实世界纵向队列研究的结果表明，非情感性精神病与双相情感障碍治疗后的BMI变化无显著差异，而在抗精神病药物处方后的前5年中，43%的人保持健康体重。
