Characteristics Of Early Metabolic Risk In Patients With First-episode Schizophrenia

BackgroundThe mortality rate of schizophrenic patients is two to three times that of the normal population.The main causes of death are diseases caused by cardiovascular diseases and obesity and have become a public health problem.There are many factors that lead to cardiovascular metabolic disorders in schizophrenia,including factors associated with schizophrenia,such as genetic factors,negative emotions,unhealthy diet and lifestyle habits,poverty,poor medical conditions,and antipsychotic medications.Wait.Antipsychotic drugs reduce the mortality rate and are the most important measures for the treatment of schizophrenia.However,long-term drug treatment can cause abnormal cardiovascular metabolism.However,reports of metabolic effects of early and early disease treatment using antipsychotic drugs are not consistent.ObjectiveThe metabolic features in the earliest stages of both schizophrenia illness and antipsychotics treatment are less clear.This study aimed to characterize the metabolic features of those patients.MethodsA total of 417 first-episode schizophrenia(FES)patients aged 13-60 years old from the Institute of Psychiatric Hospital of Henan Province(formerly the Second Affiliated Hospital of Xinxiang Medical College)were selected for study from 2008 to 2011.Social demographic information(age,sex,nationality,place of origin,occupation,degree of education,biochemical interval before and after medication,etc.),days of hospitalization,duration of illness,type of medication and daily dose,and before and after antipsychotic treatment(first time after admission Body weight,height,diastolic blood pressure,systolic blood pressure,fasting blood glucose,total cholesterol,triglycerides,HDL-C,LDL-C,serum total protein,albumin,urea,uric acid,and creatinine were examined and checked before discharge.This study uses the above information and the Chinese People's Health Database(CNPHD,2006-2010)as a control,descriptive analyses of the entire sample,to describe the metabolic indicators of the early disease and early antipsychotic treatment of patients with first-episode schizophreni,assessing the effect of drugs on metabolic indicators.The x~2 test and paired t-test were used to compare the levels at admission and after treatment,When it came to compared the different metabolic effect between the antipsychotics groups,baseline BMI and drugexposure duration were controlled as covariates by ANCOVA analysis.The stepwise regression analysis were conducted to explore the association between the change of metabolic indices(?:value after exposure-value at baseline)and BMI at baseline,treatment duration,antipsychotics.Statistical analysis was conducted using the Statistical Package forSocial Sciences(SPSS,21.0).Statistical significance was definedas P<0.05.ResultsThe prevalence of hypertriglyceridemia,hypercholesterolemia,high LDL-C and hyperglycemia in FES patients was much lower than that in the general population(7.5%vs 14.9%,9.2%vs 18.4%,8.1%vs14.9%,8.6%vs18.3%%),while the prevalence of low HDL-C in FES patients was significantly higher than that in the general population(19.9%vs 6.4%).After the antipsychotic treatment(average of 23 days),the patient's metabolic risk was significantly increased and the BMI index was significantly higher[22.0(3.2)vs.21.3(3.4),P<0.001].Before treatment,obesity/overweight accounted for 19.7%and weight loss was 18.7%.At discharge,obesity/overweight was 22.0%,and weight loss was 12.2%.The prevalence of hypertension decreased(4.53%vs 1.6%).Lipid metabolism was significant and reached a critical value(37.8%vs 45.8%P=0.091).After short-term treatment,the patient's total cholesterol(P=0.001),non-HDL-C increased(P<0.001),triglycerides(P<0.001),hypertriglyceridemia(23.6%vs 7.1%,P<0.001)increased and LDL-C(28.8%vs 19.4%,P=0.012)decreased.By comparing the ratio of triglyceride to high-density lipoprotein,it was found that the patient's insulin resistance was significantly higher(1.75±2.98 vs 0.83±0.53,n=143,paired t test,P<0.001).Despite significant increases in metabolic risk(such as lipid abnormalities and insulin resistance),mean fasting blood glucose and glycated serum protein decreased significantly after short-term(average 23 days)antipsychotic treatment compared to baseline.There was no significant difference in the metabolic profile of antipsychotics and combination therapy alone.ConclusionsThese results demonstrate the early-onset nature of HDL-C abnormalities in patients with schizophrenia early in the disease and in the treatment of early FES with antipsychotics.After exposure to antipsychotic drugs,the risk of lipid metabolism may develop rapidly in the early stages.In order to detect and prevent the early metabolic risks of diabetes and cardiovascular disease that may be caused,it is necessary to monitor early on in patients with schizophrenia and early treatment with antipsychotic drugs.