Metabolic syndrome in first episode Schizophrenia, based on the National Mental Health Registry of Schizophrenia (NMHR) in Hospital Kuala Lumpur, 10 year naturalistic follow up study / Lee Muh Haur Albert

Lee, Muh Haur Albert (2016) Metabolic syndrome in first episode Schizophrenia, based on the National Mental Health Registry of Schizophrenia (NMHR) in Hospital Kuala Lumpur, 10 year naturalistic follow up study / Lee Muh Haur Albert. Masters thesis, University of Malaya.

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Abstract

Metabolic Syndrome is a worrying issue globally. Patients with Schizophrenia have a higher risk then normal in developing this disease. This is the first 10 year retrospective outcome study of metabolic syndrome and schizophrenia in Malaysia. Objective: To investigate the rate of metabolic syndrome in schizophrenia over ten years and its associated factors. Method: 174 patients who were registered with the National Mental Health Registry of Schizophrenia (NMHR) Hospital Kuala Lumpur in 2004 - 2005, were analyzed and their progress was reviewed over the last ten years. Results: After 10 years, all patients weight, body mass index, fasting blood sugar and blood pressure are significantly increased. A total of 63 subjects (36.2%) developed metabolic syndrome while 36 (23.2%) are hypertensive, and 41 (28.1%) are diabetic. There are 3 variables which are significantly associated with metabolic syndrome namely Intra-Muscular Fluphenthixol depot (CI=1.05-5.09, OR:0.84, p=0.039), physical activity (CI=0.13-1.00, OR: -1.04, p=0.050), and substance use disorder (CI=1.40, 13.89, OR: 1.48, p=0.012). Comorbid substance abuse is still significantly associated 10 with metabolic syndrome despite adjusting for physical activity and intra-muscular depot. Female gender is more likely to have an increase in systolic blood pressure (CI=1.08- 11.82, OR: 6.45, p=0.019), while the low physical activity group has lower change in systolic BP (CI=0.33-15.60, OR: 7.96, P=0.041). High physical activity was also associated with an increase in diastolic BP (DBP) (CI= 1.51-12.91, OR: 7.21, P=0.014). Atypical antipsychotic group is 1.91 times more likely to have an increase in BMI compared to those on typical antipsychotics. Conclusion: Schizophrenia patients have a higher risk of developing metabolic syndrome. Factors which are significant in causing a greater rise in Metabolic Syndrome are the usage of IM depo fluanxol (flupentixol), comorbid substance abuse, and the lack of physical activity. A more holistic approach in assisting patients to modify the modifiable risk is needed in the management of schizophrenia. More research needs to be done in the long-term outcome of patients with schizophrenia to aid in the long term planning and management of this chronic disease.

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