Metabolic health of people admitted to a psychiatric intensive care unit in Adelaide, South Australia

Abstract

People with psychiatric disorders have high rates of comorbid obesity, cardiovascular disease, metabolic syndrome, and diabetes. These disorders are associated with poor quality of life and premature mortality. Lifestyle factors including poverty, poor diet, and lack of exercise contribute to physical comorbidity. In addition, many psychotropic drugs, including some of the atypical antipsychotics, mood stabilizers, and antidepressants, are associated with weight gain and increased risk of metabolic syndrome. A recent voluntary screening program for public mental health patients in the United States found high rates of obesity, hypertension, and elevated cholesterol, glucose, and triglycerides. John and colleagues found that 54% of Australians attending community mental health clinics met International Diabetes Federation criteria for metabolic syndrome, compared to rates of 13.4%–30.7% in the general Australian population. However, few data are available concerning the metabolic profiles of people admitted acutely to hospital with severe psychiatric disorders. We assessed a range of metabolic parameters in patients admitted involuntarily to a 10-bed, closed psychiatric intensive care unit. This service managed the most severely behaviorally disturbed patients from a catchment population of approximately 750,000 people in Adelaide, South Australia. Method. One hundred nineteen consecutive patients were admitted during the study period. Fourteen patients refused measurement of body mass index (BMI) or venipuncture; data for the remaining 105 patients are included in the analysis. This study conformed to the ethical criteria of the Australian National Health and Medical Research Council (2003). Results. The patients’ mean age was 35.21 years (SD = 10.62), and 67% were male. Men were significantly younger, on average, than the women (t = 5.15, df = 103, P < .001). Thirteen subjects (12%) were Aboriginal. The most common clinical diagnosis (DSM-IV criteria) was nonaffective psychosis (67%, n = 70), followed by bipolar disorder (21%, n = 22). The mean BMI was 27 (SD = 6.14), with 4 subjects (3.8%) being underweight (BMI < 20), 31 (29.5%) overweight (BMI = 25–30), and 32 (30.5%) obese (BMI > 30). The mean BMI did not significantly differ between men (mean = 26.9, SD = 6.25) and women (mean = 27.3, SD = 6.0). Standard laboratory criteria (Institute of Medical and Veterinary Science, Adelaide, South Australia) were utilized to interpret the blood results. The mean fasting blood glucose level was 4.9 mg/dL, and 25 subjects (23.8%) had an elevated fasting glucose level (> 5.5 mg/dL). The mean fasting cholesterol level was 4.43 mmol/L (SD = 1.34), with 16 patients (15.2%) having borderline high cholesterol (5.18–6.18 mmol/L) and a further 9 (8.6%) classified as having high cholesterol (> 6.19 mmol/L). The mean triglyceride level for the sample was 1.85 (SD = 1.20), with 43 (43.9%) having elevated triglycerides (≥ 1.6 mmol/L). The mean low-density lipoprotein cholesterol (LDL) level was 2.56 (SD = 0.91) mmol/L, and 17 patients (16.1%) had elevated LDL ≥ 2.6 mmol/L. The mean high-density lipoprotein cholesterol (HDL) level was 1.19 (SD = 0.32) mmol/L. Men had significantly lower HDL (t = 2.49, df = 96, P = .015). For each unit increase in HDL, BMI decreased by 4.49 (P = .019). There was a mean weight gain of 2.45 kg during hospitalization. The mean length of stay was 11.6 days, so patients gained a mean of 0.22 kg/d. Contributing factors include the lack of opportunity to exercise and a policy of allowing patients to purchase confectionery, chips, and soft drinks. Ninety percent of our sample (n = 95) were treated with olanzapine, clozapine, and/or sodium valproate. The mean weight gain was greater for patients treated with these medications, a lthough these differences did not reach significance. However, other medications with a more favorable metabolic profile are clearly preferable, even in the acute setting. Our study shows that about ...