First-Episode Psychosis May Be a Key Intervention Point for Cardiometabolic Risk

The word "psychosis" on paper.
Adverse cardiometabolic outcomes were more commonly observed among patients from black and ethnic minority groups compared with white patients.

Study data published in the British Journal of Psychiatry suggest that there may be an increased risk for obesity and glucose dysregulation in the year following first-episode psychosis. Furthermore, adverse cardiometabolic outcomes were more commonly observed among patients from black and ethnic minority groups compared with white patients.

Co-first authors Fiona Gaughran, MD, and Daniel Stahl, PhD, both from the Institute of Psychiatry, Psychology and Neuroscience at Kings College London, United Kingdom, led this prospective cohort study of adults with first-episode psychosis, examining cardiometabolic outcomes. Eligible patients were 16 to 65 years of age without any severe comorbid physical illness.

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Mental health teams evaluated participants at baseline and at 12 months’ follow-up. Sociodemographic characteristics were extracted at baseline, and at both time points, the investigators assessed mental health status, physical activity, dietary intake, medication use, substance use, and cardiometabolic measures, including body mass index, hemoglobin levels, and blood pressure. Linear regression models were used to assess the relationship among individual, lifestyle, and cardiometabolic factors.

Overall, 293 patients (mean age, 30.6±10.5 years; 64.8% men; 46.4% white) contributed data for analyses. Complete follow-up data were available for 125 patients. At 1 year, rates of obesity and glucose dysregulation had each risen to 23.7%, compared with 17.8% and 12.0% at baseline, respectively.

Tobacco use was highly prevalent but did not significantly change between baseline (76.8%) and follow-up (73.3%). Rates of sedentary behavior also did not change significantly over follow-up, with 27.5% at baseline and 26.4% at follow-up reporting ≥10 hours of daily sedentary activity. No significant associations were observed between cardiometabolic outcomes at 1 year and baseline lifestyle factors or antipsychotic medication use.

Among patients from black and minority ethnic groups, hemoglobin A1C increased by 3.3 mmol/mol from baseline to 12 months; the same increase was not observed among white participants. Additionally, at 1 year, 34.0% of patients from black or ethnic minority groups had hemoglobin A1C levels indicating prediabetes (≥39 mmol/mol) compared with just 10.0% of white patients. Rates of obesity at baseline were elevated in women compared with men (62.7% vs 35.3%; P =.001), trending higher among women from black and minority ethnic groups compared with white women (P =.02).

Overall, cardiometabolic risk tended to worsen over follow-up, with effects particularly pronounced in patients from black and minority ethnic groups. While unhealthy lifestyle choices were prevalent in the first year following first-episode psychosis, no specific habits were associated with significantly increased cardiometabolic risk.

As study limitations, investigators noted that differences may exist between study completers and those lost to follow-up despite efforts made to reduce attrition. The researchers noted that “in psychosis, the rapidity of weight gain over the first year offers an unrivalled opportunity for prevention, with diet, exercise and medication being key targets.”


Gaughran F, Stahl D, Stringer D, et al. Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study. Br J Psychiatry. 2019;215(6):712-719.