Psychiatric patients with altered metabolic profile may not receive adequate treatment

Celine Dubath

Psychiatric patients have a higher prevalence of metabolic syndrome than the general population and may not receive adequate treatment for metabolic disruptions, according to results of a Swiss population-based cohort study published in Journal of Clinical Psychiatry.

"The comparison of a large psychiatric cohort with a population-based cohort sheds light on the importance of metabolic disturbances among the psychiatric population," Céline Dubath, PharmD, of the department of psychiatry at Lausanne University Hospital in Switzerland, told Healio Psychiatry. "The low proportion of patients receiving adequate care reveals an unmet medical need. These findings emphasize the need to integrate physical evaluation and treatment in every mental health care facility."

According to Dubath and colleagues, metabolic syndrome better predicts CVD events than the sum of isolated risk factors. Thus, it is commonly used as an early diagnostic tool to aid decision-making regarding treatment interventions. Further, prior research has shown that individuals with psychiatric are at higher risk for CVD than the general population; however, these differences not well characterized and are poorly understood.

To address this research gap, Dubath and colleagues aimed to assess CVD risk — defined as presence of metabolic syndrome and calculated 10-year CVD risk — in among Swiss psychiatric patients taking psychotropic drugs associated with weight gain. They then sought to compare these findings with a Swiss population-based cohort and evaluate the prevalence of treatment for metabolic disruptions among participants in both cohorts.

The researchers obtained data of 6,733 participants of the CoLaus|PsyCoLaus study — a population-based study conducted between 2003 and 2006 that included participants aged 35 years to 75 years. They obtained additional data of 1,216 psychiatric patients, of whom 634 were aged 35 years to 75 years, between 2007 and 2017 from a study that included metabolic parameters during psychotropic treatment.

Dubath and colleagues identified metabolic syndrome, as defined by the International Diabetes Foundation (IDF), in 33% of the psychiatric participants and 24.7% of the population-based subjects. Prevalence according to the IDF was more than three times higher among women aged 35 years to 49 years (25.6% vs. 8%) in the psychiatric cohort. The researchers observed comparable predicted CVD risk between the psychiatric and population-based cohorts. Further, they observed no difference among the proportion of participants with metabolic syndrome treated for metabolic disturbance in both cohorts, except for women aged 35 years to 49 years, for whom those in the psychiatric cohort were 50% less likely to receive treatment compared with participants in the population-based cohort.

“I was not expecting to observe such strong differences between the psychiatric and population-based cohorts compared in this study," Dubath said. "Both observed samples live in the same geographic area and have access to the same health care system. I found it very frustrating to witness these inequalities." – by Joe Gramigna

Disclosures: Dubath reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.