Metabolic Syndrome Prevalent in Those Treated With Long-Acting Injectable Antipsychotics

Metabolic syndrome and cardiometabolic risk factors may be highly prevalent among patients with severe mental illness prescribed long-acting injectable (LAI) antipsychotic medications, according to study results published in Psychiatry Research.

The study also emphasized the importance of addressing physical health needs of patients with severe mental illness, whose life expectancy is 12 to 15 years shorter and who experience cardiovascular disease and diabetes rates higher than the general population.

Compared with oral antipsychotic medications, LAIs have been commended for their pharmacokinetic benefits and their potential to facilitate improved adherence and lower rates of relapse. However, little is known about their effect on cardiometabolic outcomes.

Researchers conducted an observational, cross-sectional study across 3 hospital sites in Australia between October 2016 and December 2017. They recruited patients connected to community mental health services who were prescribed LAIs for schizophrenia, schizoaffective disorder, or bipolar affective disorder. Assessments, performed as part of routine care, included cardiometabolic risk factors and metabolic syndrome as primary outcome measures, as well as sociodemographic, anthropometric, blood test, and lifestyle details (smoking, physical, and dietary activity). Metabolic syndrome was defined according to the International Diabetes Federation criteria.

Of 301 eligible patients, 197 (65.4%) were men (mean age, 44.4±12.3 years), and 86 (43.7%) met the International Diabetes Federation criteria for metabolic syndrome. Cardiometabolic risk factors were undertreated or untreated in this population. Rates of smoking (62.1%) were high, whereas physical activity (10.7%) and healthy diet tendencies were very low. Few patients had received any physical activity, weight management, or diet advice in the prior year. Polypharmacy was common among the cohort (36.2%), which could influence cardiometabolic outcomes.

The results highlight the importance of addressing metabolic syndrome and associated health risks in patients with severe mental illness, particularly those prescribed LAIs. Study limitations included reliance on self-report data, which could lead to unreliable claims about the physical activity, diet, and smoking habits of patients.

“Better collaboration between mental health services and primary care should be pursued in order to optimise the delivery of effective care to individuals with [severe mental illness],” the investigators wrote.

Reference

Morell R, Curtis J, Watkins A, et al. Cardio-metabolic risk in individuals prescribed long-acting injectable antipsychotic medication. Psychiatry Res. 2019;281:112606.