Skip to main content

Advertisement

SpringerLink
Log in

Assessment of cardiovascular disease risk in patients with schizophrenia spectrum disorders in German psychiatric hospitals: results of the pharmacoepidemiologic CATS study

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Patients with severe mental illness are at high risk for metabolic and cardiac disorders. Thus, monitoring of cardiovascular risks is imperative and schedules for screening for lipids, glucose, body mass index (BMI), waist-hip ratio and blood pressure have been developed. We intended to analyze screening for metabolic disorders in German patients with schizophrenia spectrum disorders in routine psychiatric care.

Methods

We included 674 patients with any F2 diagnosis in out- and inpatient settings and analyzed metabolic screening procedures as practiced under conditions of usual care.

Results

Except BMI (54 %), all other values were documented only in a minority of patients: waist circumference (23 %), cholesterol (28 %), fasting glucose (19 %), triglycerides (25 %) and blood pressure (37 %). We found evidence for less than perfect quality of blood pressure measures. The group of patients who met the individual metabolic syndrome ATP III criteria was comparable to the US CATIE trial.

Conclusions

We conclude that frequency and quality of metabolic monitoring in German in- and outpatients settings are not in accordance with the respective recommendations. Similar to previous reports we found evidence for a high prevalence of metabolic disturbances in German patients with schizophrenia spectrum disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Osby U, Correia N, Brandt L, Ekbom A, Sparén P (2000) Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 45:21–28

    Article  PubMed  CAS  Google Scholar 

  2. Wegelius A, Tuulio-Henriksson A, Pankakoski M, Haukka J, Lehto U, Paunio T et al (2011) An association between high birth weight and schizophrenia in a Finnish schizophrenia family study sample. Psychiatry Res 190:181–186

    Article  PubMed  Google Scholar 

  3. Alkelai A, Greenbaum L, Lupoli S, Kohn Y, Sarner-Kanyas K, Ben-Asher E et al (2012) Association of the type 2 diabetes mellitus susceptibility gene, TCF7L2, with schizophrenia in an Arab-Israeli family sample. PLoS One 7:e29228. doi:10.1371/journal.pone.0029228

    Article  PubMed  CAS  Google Scholar 

  4. Fernandez-Egea E, Miller B, Bernardo M, Donner T, Kirkpatrick B (2008) Parental history of type 2 diabetes in patients with nonaffective psychosis. Schizophr Res 98:302–306

    Article  PubMed  Google Scholar 

  5. Mukherjee S, Schnur DB, Reddy R (1989) Family history of type 2 diabetes in schizophrenic patients. Lancet 1:495

    Article  PubMed  CAS  Google Scholar 

  6. Chwastiak LA, Rosenheck RA, Kazis LE (2011) Association of psychiatric illness and obesity, physical inactivity, and smoking among a national sample of veterans. Psychosomatics 52:230–236

    Article  PubMed  Google Scholar 

  7. Gupta A, Craig TK (2009) Diet, smoking and cardiovascular risk in schizophrenia in high and low care supported housing. Epidemiol Psichiatr Soc 18:200–207

    PubMed  Google Scholar 

  8. Brown S, Birtwistle J, Roe L, Thompson C (1999) The unhealthy lifestyle of people with schizophrenia. Psychol Med 29:697–701

    Article  PubMed  CAS  Google Scholar 

  9. Vancampfort D, Probst M, de Herdt A, Corredeira RM, Carraro A, de Wachter D, de Hert M (2013) An impaired health related muscular fitness contributes to a reduced walking capacity in patients with schizophrenia: a cross-sectional study. BMC Psychiatry 13:5. doi:10.1186/1471-244X-13-5

    Article  PubMed  Google Scholar 

  10. Laursen TM, Munk-Olsen T, Vestergaard M (2012) Life expectancy and cardiovascular mortality in persons with schizophrenia. Curr Opin Psychiatry 25:83–88

    Article  PubMed  Google Scholar 

  11. Brown S, Mitchell C (2012) Predictors of death from natural causes in schizophrenia: 10-year follow-up of a community cohort. Soc Psychiatry Psychiatr Epidemiol 47:843–847

    Article  PubMed  Google Scholar 

  12. Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC et al (1999) Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 156:1686–1696

    PubMed  CAS  Google Scholar 

  13. Smith M, Hopkins D, Peveler RC, Holt RI, Woodward M, Ismail K (2008) First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 192:406–411

    Article  PubMed  CAS  Google Scholar 

  14. Chaggar PS, Shaw SM, Williams SG (2011) Effect of antipsychotic medications on glucose and lipid levels. J Clin Psychiatry 51:631–638

    CAS  Google Scholar 

  15. Falissard B, Mauri M, Shaw K, Wetterling T, Doble A, Giudicelli A, de Hert M (2011) The METEOR study: frequency of metabolic disorders in patients with schizophrenia. Focus on first and second generation and level of risk of antipsychotic drugs. Int Clin Psychopharmacol 26:291–302

    Article  PubMed  Google Scholar 

  16. Newcomer JW (2007) Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry 68(Suppl 1):20–27

    PubMed  CAS  Google Scholar 

  17. Stahl SM, Mignon L, Meyer JM (2009) Which comes first: atypical antipsychotic treatment or cardiometabolic risks? Acta Psychiatr Scand 119:171–179

    Article  PubMed  CAS  Google Scholar 

  18. Rummel-Kluge C, Komossa K, Schwarz S, Hunger H, Schmid F, Lobos CA, Kissling W, Davis JM, Leucht S (2010) Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis. Schizophr Res 123:225–233

    Article  PubMed  Google Scholar 

  19. Oud MJ, Meyboom-de Jong B (2009) Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care. BMC Fam Pract 10:32

    Article  PubMed  Google Scholar 

  20. Morrato EH, Cuffel B, Newcomer JW, Lombardo I, Kamat S, Barron J (2009) Metabolic risk status and second-generation antipsychotic drug selection: a retrospective study of commercially insured patients. J Clin Psychopharmacol 29:26–32

    Article  PubMed  CAS  Google Scholar 

  21. Morrato EH, Druss B, Hartung DM, Valuck RJ, Allen R, Campagna E, Newcomer JW (2010) Metabolic testng rates in 3 state Medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs. Arch Gen Psychiatry 67:17–24

    Article  PubMed  Google Scholar 

  22. Nasrallah HA, Meyer JM, Goff DC, McEvoy JP, Davis SM, Stroup TS et al (2006) Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res 86:15–22

    Article  PubMed  Google Scholar 

  23. De Hert M, Vancampfort D, Correll CU, Mercken V, Peuskens J, Sweers K, van Winkel R, Mitchell AJ (2011) Guidelines for screening and monitoring of cardiometabolic risk in schizophrenia. Br J Psychiatry 199:99–105

    Article  PubMed  Google Scholar 

  24. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity (2004) Consensus development conference on antipsychotic drugs and obesity and diabetes. J Clin Psychiatry 65:267–272

    Article  Google Scholar 

  25. De Hert M, Dekker JM, Wood D, Kahl KG, Holt RI, Möller HJ (2009) Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 24:412–424

    Article  PubMed  Google Scholar 

  26. Mackin P, Bishop DR, Watkinson HM (2007) A prospective study of monitoring practices for metabolic disease in antipsychotic-treated community psychiatric patients. BMC Psychiatry 7:28

    Article  PubMed  Google Scholar 

  27. Buckley PF, Miller DD, Singer B, Arena J, Stirewalt EM (2005) Clinicians’ recognition of the metabolic adverse effects of antipsychotic medications. Schizophr Res 79:281–288

    Article  PubMed  Google Scholar 

  28. Haupt DW, Rosenblatt LC, Kim E, Baker RA, Whitehead R, Newcomer JW (2009) Prevalence and predictors of lipid and glucose monitoring in commercially insured patients treated with second-generation antipsychotic agents. Am J Psychiatry 166:345–353

    Article  PubMed  Google Scholar 

  29. Newcomer JW, Nasrallah HA, Loebel AD (2004) The atypical antipsychotic therapy and metabolic issues National Survey: practice patterns and knowledge of psychiatrists. J Clin Psychopharmacol 24(Suppl 1):1–6

    Article  Google Scholar 

  30. Mitchell AJ, Delaffon V, Vancampfort D, Correll CU, de Hert M (2012) Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med 42:125–147

    Article  PubMed  CAS  Google Scholar 

  31. Deuschle M, Bergemann N, Kammerer-Ciernioch J, Franz M, Lautenschlager M, Lederbogen F et al (2008) Clinical analyses of the treatment of schizophrenia, CATS: Grundlagen einer pharmakoepidemiologischen Studie zur Qualität der Versorgung von Patienten mit Schizophrenie. Psychopharmakotherapie 15:147–152

    Google Scholar 

  32. Ford ES, Abbasi F, Reaven GM (2005) Prevalence of insulin resistance and the metabolic syndrome with alternative definitions of impaired fasting glucose. Atherosclerosis 181:143–148

    Article  PubMed  CAS  Google Scholar 

  33. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26(Suppl 1):5–20

    Google Scholar 

  34. McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L et al (2005) Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the clinical antipsychotic trials of intervention effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res 80:19–32

    Article  PubMed  Google Scholar 

  35. Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, de Hert M (2011) Prevalence of metabolic syndrome an metabolic abnormalities in schizophrenia and related disorders—a systematic review and meta-analysis. Schizophr Bull. doi:10.1093/schbul/sbr148

    PubMed  Google Scholar 

  36. Sicras-Mainar A, Blanca-Tamayo M, Rejas-Gutiérrez J, Navarro-Artieda R (2008) Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a cross-sectional assessment of a primary health care database. Eur Psychiatry 23:100–108

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Pfizer, Germany.

Conflict of interest

M. D. Advisory activity for Bristol Myers Squibb and Otsuka Pharma. Speaker fees from Bristol Myers Squibb, Otsuka and Lilly. Investigator in Roche and Lilly studies. F. P., M. B., J. K.-C., M. L., F. L., D. R.-E., M. W., J. R. No conflict of interest. N. B. Conferences: invitations as contributor for Bristol-Myers Squibb, Novartis, Otsuka, Pfizer, Servier. Sponsoring and grants by AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen-Cilag, Lilly, Lundbeck, Novartis, Novo Nordisk, Otsuka, Pfizer, Sanofi-Aventis, Servier, Wyeth. Clinical trials: acting as principal investigator or co-investigator for AstraZeneca, Bristol-Myers Squibb, Desitin, Pfizer, Otsuka, and Servier; advisory activities for AstraZeneca, Bristol-Myers Squibb, Novartis, and Otsuka. M. F. Received speakers fees and sponsoring for symposia from Astra Zeneca, Norvatis, Lilly, Lundbeck, Janssen-Cilag, Pfizer, Servier, Bristol-Myers Squibb, GlaxoSmithKline. K. G. K. Received speaker honoraria by AstraZeneca, BMS, GSK, EliLilly, Janssen-Cilag, Otsuka, Pfizer. J. G., J. U. Staff of Pfizer Deutschland GmbH.

Author information

Authors and Affiliations

  1. Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany

    M. Deuschle, F. Paul & F. Lederbogen

  2. StatConsult Gesellschaft für klinische und Versorgungsforschung mbH, Halberstädter Str. 40a, 39112, Magdeburg, Germany

    M. Brosz & J. Reichmann

  3. Schön Klinik Bad Arolsen, Hofgarten 10, 34454, Bad Arolsen, Germany

    N. Bergemann

  4. Vitos Kurhessen Klinik für Psychiatrie und Psychotherapie Bad Emstal, Landgraf-Philipp-Straße 9, 34308, Bad Emstal, Germany

    M. Franz

  5. Klinik für Allgemeinpsychiatrie, Psychotherapie und Psychosomatik I, Psychiatrisches Zentrum Nordbaden, Heidelberger Straße 1a, 69168, Wiesloch, Germany

    J. Kammerer-Ciernioch

  6. Department of Psychiatry and Psychotherapy, Charite Berlin, Chariteplatz 1, 10117, Berlin, Germany

    M. Lautenschlager

  7. Klinik für Allgemeine Psychiatrie, Sektion Experimentelle Psychopathologie und Neurophysiologie, Universität Heidelberg, Voßstraße 4, 69115, Heidelberg, Germany

    D. Roesch-Ely

  8. Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Germany

    M. Weisbrod

  9. Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    K. G. Kahl

  10. Pfizer Deutschland GmbH, Linkstraße 10, 10785, Berlin, Germany

    J. Gross & J. Umbreit

Authors
  1. M. Deuschle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Brosz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Bergemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Franz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Kammerer-Ciernioch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Lautenschlager
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Lederbogen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Roesch-Ely
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Weisbrod
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. K. G. Kahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. J. Reichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. J. Umbreit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Paul.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Deuschle, M., Paul, F., Brosz, M. et al. Assessment of cardiovascular disease risk in patients with schizophrenia spectrum disorders in German psychiatric hospitals: results of the pharmacoepidemiologic CATS study. Soc Psychiatry Psychiatr Epidemiol 48, 1283–1288 (2013). https://doi.org/10.1007/s00127-013-0676-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0676-0

Keywords

Search

Navigation