Metabolic risk in people with psychotic disorders

People with psychotic disorders have an increased metabolic risk and a shortened mean life expectancy compared to the general population. Routine outcome monitoring of metabolic risk factors in these patients is therefore recommended and has been implemented in the northern Netherlands for several years.

This thesis shows that despite regular monitoring, only 43-50% of the patients receives treatment for metabolic risk factors when this is recommended by treatment guidelines. One of the factors associated with increased metabolic risk, discussed in this thesis, is vitamin D insufficiency. This relation can be explained by a complex model invoking the role of negative symptoms, antipsychotics and an unhealthy lifestyle.

Furthermore, this thesis demonstrates that cannabis users have a lower BMI, smaller waist circumference and lower diastolic blood pressure, but also more severe psychotic symptoms than non-users. After one year, cannabis discontinuers had a greater increase in BMI, waist circumference, diastolic blood pressure and triglycerides, and a greater decrease in psychotic symptoms than other patients. Patients with a specific AKT1 gene more often used cannabis, but this did not influence the association between cannabis use and BMI.

This thesis also shows that patients’ metabolic risk can be decreased according to the lifestyle interventions studied to date (decreased body weight, waist circumference, triglycerides and fasting glucose concentrations), but not remedied (no improvements on blood pressure or cholesterol). This thesis emphasises that monitoring does not automatically result in better care. This suggests we should urgently examine the efficacy of current monitoring, referral and treatment practices.

Dissertation: http://hdl.handle.net/11370/8bfcf53f-f126-46ef-a68a-6f6835db0e3d