Metabolic Syndrome Among Persons With Schizophrenia and Other Psychotic Disorders in a General Population Survey

Jaana M. Suvisaari, M.D., Ph.D.; Samuli I. Saarni, M.D., M.Soc.Sc.; Jonna Perälä, M.D.; Janne V. J. Suvisaari, M.D., Ph.D.; Tommi Härkänen, Ph.D.; Jouko Lönnqvist, M.D., Ph.D.; and Antti Reunanen, M.D., Ph.D.

Objective: To determine the prevalence of metabolic syndrome and investigate its components in individuals with psychotic disorders and individuals using antipsychotic medication in a general population study.

Method: The study population was a nationally representative, 2-stage cluster sample of 8028 persons aged 30 years or over from Finland. The field work for this study took place between September 2000 and June 2001. Laboratory and other measurements related to metabolic syndrome were taken in a health examination. We used the Structured Clinical Interview for DSM-IV (SCID-I) and case note data when making diagnostic assessments according to DSM-IV-TR criteria. Metabolic syndrome was diagnosed according to Adult Treatment Panel III criteria. Subjects who had not fasted the required 4 hours were excluded from the analysis. Prevalences of metabolic syndrome, adjusting for age, sex, and hours of fasting, were estimated by calculating predicted marginals, evaluated at 8 hours of fasting.

Results: The prevalence estimates of metabolic syndrome were 36.2% (SE = 7.3), 41.4% (SE = 6.3), and 25.0% (SE = 8.6) among subjects with schizophrenia, other nonaffective psychosis, and affective psychosis, respectively, compared with 30.1% (SE = 0.8) in subjects without psychotic disorders. Subjects with schizophrenia had significantly lower high-density lipoprotein cholesterol and higher triglyceride and glucose levels and larger waist circumference, but also lower systolic blood pressure, than the remaining study population (all p values < .05). While all markers of metabolic syndrome were elevated among subjects with other nonaffective psychotic disorders, only the difference in waist circumference was statistically significant (p < .05). The prevalence of metabolic syndrome was significantly elevated among users of high-potency (52.1% [SE = 6.6]; p < .001) but not low-potency (39.0% [SE = 6.9]) and atypical (23.4% [SE = 10.8]) antipsychotic medication.

Conclusion: Nonaffective psychotic disorders are associated with abdominal obesity and glucose and lipid abnormalities. Regular monitoring and active treatment of metabolic abnormalities are essential in this patient population.

(J Clin Psychiatry 2007;68:1045-1055)

Received Aug. 20, 2006; accepted Nov. 16, 2006. From the Department of Mental Health and Alcohol Research (Drs. J. M. Suvisaari, Saarni, Perälä, and Lönnqvist) and the Department of Health and Functional Capacity (Drs. Härkänen and Reunanen), National Public Health Institute, Helsinki; the Department of Social Psychiatry, Tampere School of Public Health, University of Tampere, Tampere (Dr. J. M. Suvisaari); the Laboratory of Helsinki University Central Hospital, and Malmi Hospital, Laboratory Division of the Hospital District of Helsinki and Uusimaa (HUSLAB), Helsinki (Dr. J. V. J. Suvisaari); and the Department of Psychiatry, University of Helsinki, and Helsinki University Central Hospital, Helsinki (Dr. Lönnqvist), Finland.

This study has been supported by grants from the Stanley Medical Research Institute and the Yrjö Jahnsson Foundation (Dr. J. M. Suvisaari) and by a grant from the Academy of Finland (Dr. Lönnqvist).

Presented in part at the 2007 International Congress on Schizophrenia Research, March 28-April 1, 2007, Colorado Springs, Colo.

Dr. J. M. Suvisaari is a stock shareholder in Orion Pharma. Drs. Saarni, Perälä, J. V. J. Suvissaari, Härkänen, Lönnqvist, and Reunanen report no additional financial or other relationships relative to the subject matter of this article.

Corresponding author and reprints: Jaana M. Suvisaari, M.D., Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland (e-mail: jaana.suvisaari@ktl.fi).