Cardiovascular risk factors in patients with severe mental illness

Abstract

Individuals with severe mental illness have much higher mortality rates from somatic diseases than the general population. Cardiovascular disease is the leading cause of death, and, contrary to the general population, cardiovascular mortality in psychiatric patients has not declined over the last decades. The main aim of the clinical studies performed in this thesis in psychiatry was to gain more knowledge about the prevalence and causes of cardiovascular risk factors in patients with severe psychiatric disorders, with particular emphasis on the metabolic side effects of antipsychotic treatment. <br><br>

The studies were based upon naturalistic data from the cross-sectional part of the Thematically Organized Psychosis Research (TOP) Study, carried out in joint collaboration between the University and University Hospitals of Oslo. Eligible patients were all those (1) registered in the psychiatric services of one of the University Hospitals in Oslo; (2) aged 18 to 65 years; (3) meeting DSM-IV criteria for a major psychotic illness; and (4) being able and willing to give informed, written consent of participation. From October 2002 through July 2006 a total of 414 patients were included, from all health care sectors of Oslo. Reference data were based upon the 2000/2001 Oslo Health Study (HUBRO), including a total of 18,770 individuals from the general population of Oslo. <br><br>

Most known cardiovascular risk factors were found to be approximately twice as prevalent in the study sample as in the general population, and young patients had the highest relative increase in risk. Differences in risk profiles between patients and references could not be explained by sociodemographic factors alone. Subjects with schizophrenia and bipolar disorder had approximately the same level of risk factors. Antipsychotic treatment with certain second generation drugs was associated with dyslipidemia, insulin resistance and increased levels of circulating leptin, independent of body mass and body composition. Women seemed to be particularly at risk for dysregulation of metabolism following antipsychotic treatment.