诊断为精神病后的体重变化:英国大曼彻斯特地区的一项回顾性队列研究

IF 3.6 3区 医学 Q1 PSYCHIATRY Annals of General Psychiatry Pub Date : 2024-01-03 DOI:10.1186/s12991-023-00485-8
Adrian Heald, Chris Daly, John Julian Warner-Levy, Richard Williams, Cheyenne Meehan, Mark Livingston, Toby Pillinger, Lamiece Hussain, Joseph Firth
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引用次数: 0

摘要

严重持久性精神疾病(SMI)确诊/治疗后数月/数年内体重增加是未来糖尿病、代谢紊乱和心血管代谢疾病风险增加的主要预测因素。关于有 SMI 病史的人的长期体重变化情况以及不同个体之间的差异,目前的数据还很有限。我们在此报告一项关于英国大曼彻斯特地区 SMI 诊断后 5 年内体重变化的回顾性研究,该地区是一个种族和文化多元化的社区,研究重点是比较非情感性精神病(NAP)和情感性精神病(AP)的诊断结果。我们在大曼彻斯特护理记录 (GMCR) 中进行了匿名搜索。我们查阅了首次被诊断为首发精神病、精神分裂症、情感分裂症、妄想性障碍(非情感性精神病 = NAP)或情感性精神病(AP)患者的健康记录。我们分析了首次开具抗精神病药物处方后 5 年间的体重指数(BMI)变化。所有患者都服用过至少 3 个月的抗精神病药物。5 年随访时间为 2003 年至 2023 年。我们确定了 9125 名具有上述诊断的患者。非精神病患者(n = 5618;37.3% 为女性)的平均年龄为 49.9 岁;精神病患者(n = 4131;60.5% 为女性)的平均年龄为 48.7 岁。27.0%的非白种人(NAP)与17.8%的白种人(AP)相比。被诊断出患有非传染性疾病的人中,处于社会不利地位最高五分位数的人所占比例较高,为 52.4%,而被诊断出患有传染性疾病的人中,处于社会不利地位最低五分位数的人所占比例为 39.5%。基线体重指数没有明显差异。在有 HbA1c 数据的子样本(n = 2103)中,NAP 患者的平均 HbA1c 基线更高(NAP 患者为 40.4 mmol/mol,AP 患者为 36.7 mmol/mol)。在 5 年的随访中,肥胖≥ 30 kg/m2 类别的总体百分比(国家行动方案为 39.8%,亚太方案为 39.7%)和从正常健康体重指数过渡到肥胖/超重体重指数的百分比(国家行动方案为 53.6%,亚太方案为 55.6%)均相似。在体重指数正常的 NAP 患者中,43.7% 的人的体重指数保持在健康水平,而 AP 患者的这一比例为 42.7%。在对 NAP 的 5 年随访中,BMI ≥ 30 kg/m2 的 NAP 中 83.1% 的人保持在这一水平,而 AP 中则为 81.5%。这项真实世界的纵向队列研究结果表明,在治疗非情感性精神病与双相情感障碍的过程中,BMI的变化没有显著差异,而43%的患者在服用抗精神病药物后的前5年保持了健康体重。我们在此报告一项纵向回顾性队列研究,研究对象是英国大曼彻斯特地区一个种族和文化多元化的社区中确诊为精神病后的体重变化情况,尤其关注非情感性精神病与情感性精神病的病史。
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Weight change following diagnosis with psychosis: a retrospective cohort study in Greater Manchester, UK
Weight gain in the months/years after diagnosis/treatment of severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased risk of cardiometabolic diseases. There is limited data on the longer-term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a retrospective study on weight change over the 5 years following an SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on comparing non-affective psychosis (NAP) vs affective psychosis (AP) diagnoses. We undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) or affective psychosis (AP). We analysed body mass index (BMI) change in the 5-year period following the first prescription of antipsychotic medication. All individuals had taken an antipsychotic agent for at least 3 months. The 5-year follow-up point was anywhere between 2003 and 2023. We identified 9125 people with the diagnoses above. NAP (n = 5618; 37.3% female) mean age 49.9 years; AP (n = 4131; 60.5% female) mean age 48.7 years. 27.0% of NAP were of non-White ethnicity vs 17.8% of AP individuals. A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for AP. There were no significant differences in baseline BMI profile. In a subsample with HbA1c data (n = 2103), mean HbA1c was higher in NAP at baseline (40.4 mmol/mol in NAP vs 36.7 mmol/mol for AP). At 5-year follow-up, there was similarity in both the overall % of individuals in the obese ≥ 30 kg/m2 category (39.8% NAP vs 39.7% AP), and % progressing from a normal healthy BMI transitioned to obese/overweight BMI (53.6% of NAP vs 55.6% with AP). 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7% with AP. At 5-year follow-up for NAP, 83.1% of those with BMI ≥ 30 kg/m2 stayed in this category vs 81.5% of AP. The results of this real-world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, while 43% maintain a healthy weight in the first 5 years following antipsychotic prescription. We here report a longitudinal retrospective cohort study on weight change post-SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community with particular focus on a history of non-affective psychosis vs affective psychosis disorder.
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来源期刊
CiteScore
6.60
自引率
2.70%
发文量
43
审稿时长
>12 weeks
期刊介绍: Annals of General Psychiatry considers manuscripts on all aspects of psychiatry, including neuroscience and psychological medicine. Both basic and clinical neuroscience contributions are encouraged. Annals of General Psychiatry emphasizes a biopsychosocial approach to illness and health and strongly supports and follows the principles of evidence-based medicine. As an open access journal, Annals of General Psychiatry facilitates the worldwide distribution of high quality psychiatry and mental health research. The journal considers submissions on a wide range of topics including, but not limited to, psychopharmacology, forensic psychiatry, psychotic disorders, psychiatric genetics, and mood and anxiety disorders.
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