Clozapine use and sedentary lifestyle as determinants of metabolic syndrome in outpatients with schizophrenia

Abstract

Background: Schizophrenia patients are in danger of developing metabolic syndrome (MetS) and its outcomes type 2 diabetes and cardiovascular disease. Antipsychotic treatment and adverse lifestyle increase the burden of metabolic problems in schizophrenia, but little is known about the role of patients’ current psychiatric problems and living arrangements in MetS. Aims: This study aims to evaluate correlations between MetS, severity of psychiatric symptoms, living arrangements, health behaviour and antipsychotic medication in outpatients with schizophrenia spectrum disorders. Methods: A general practitioner and psychiatric nurses performed a comprehensive health examination for all consenting patients with schizophrenia spectrum disorders treated in a psychosis outpatient clinic. Examination comprised of an interview, a questionnaire, measurements, laboratory tests and a general clinical examination. Diagnosis of MetS was made according to International Diabetes Federation (IDF) definition. Correlations were calculated and logistic regression analysis performed with SAS. Results: 276 patients (men n = 152, mean age± standard deviation = 44.9 ± 12.6 years) participated in the study; 58.7% (n = 162) of them had MetS according to the IDF definition. Clozapine use doubled the risk of MetS (OR = 2.04, 95% CI 1.09–3.82, P = 0.03), whereas self-reported regular physical activity decreased the risk significantly (OR = 0.32, 95% CI 0.18–0.57, P < 0.001). We found no correlations between MetS and living arrangements or current severity of psychiatric symptoms. Conclusions: MetS was alarmingly common in our sample. Even moderate physical activity was associated with decreased risk of MetS. Promotion of a physically active lifestyle should be one of the targets in treatment of schizophrenia, especially in patients using clozapine.

• Clozapine
• Living arrangements
• Metabolic syndrome
• Physical activity
• Schizophrenia

Disclosures of interest: Funding sources had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Saana Eskelinen has received lecture fees and a grant from Lundbeck. Eila Sailas has received lecture fees from Janssen-Cilag, AstraZeneca and Lundbeck. Kaisla Joutsenniemi has received lecture fees from GlaxoSmithKline and Janssen-Cilag. Matti Holi declares to have no conflicts of interest. Jaana Suvisaari has worked as a consultant for Janssen-Cilag. The authors alone are responsible for the content and writing of the paper.

This study was supported by the Hyvinkää Hospital Area and by an unrestricted research grants from Lundbeck Inc., Finnish Foundation for Psychiatric Research, the Finnish Medical Foundation, Jalmari and Rauha Ahokas's Foundation and Emil Aaltonen's Foundation.