Pretreatment cardiometabolic status in youth with early-onset psychosis: Baseline results from the TEA trial

TY - JOUR

T1 - Pretreatment cardiometabolic status in youth with early-onset psychosis

T2 - Baseline results from the TEA trial

AU - Jensen, Karsten G.

AU - Correll, Christoph U.

AU - Rudå, Ditte

AU - Klauber, Dea G.

AU - Stentebjerg-Olesen, Marie

AU - Fagerlund, Birgitte

AU - Jepsen, Jens Richardt Møllegaard

AU - Fink-Jensen, Anders

AU - Pagsberg, Anne Katrine

PY - 2017

Y1 - 2017

N2 - Objective: To describe pretreatment cardiometabolic constitution in children and adolescents with first-episode psychosis (FEP). Methods: Baseline cardiometabolic assessment was performed in youths aged 12-17 years with FEP entering the Tolerability and Efficacy of Antipsychotics (TEA) trial and matched healthy controls. Patients were included between June 10, 2010, and January 29, 2014. ICD-10 was used as the diagnostic classification system. Cardiometabolic risk markers were compared between patients versus controls and antipsychotic-naive versus antipsychotic-exposed patients. Results: Comparing 113 youths with FEP (age ± SD = 15.74 ± 1.36 years, males = 30.1%, schizophrenia-spectrum disorders = 92.9%, antipsychoticnaive: n = 57) to 60 controls, patients had higher waist circumference (WC) zscores (1.13 ± 1.65 vs 0.42 ± 1.27, P =.018), cholesterol (4.10 ± 0.71 vs 3.79 ± 0.49 mmol/L, P =.014), low-density lipoproteins (2.37 ± 0.56 vs 2.13 ± 0.51, P =.012), and non-high-density lipoproteins (2.58 ± 1.60 vs 2.52 ± 0.52, P =.018). More patients than controls (42.9% vs 20.3%, P =.019) and antipsychotic-naive than antipsychotic-exposed (51.9% vs 34.0%, P =.023) had a WC > 90th percentile. Hypercholesterolemia (34.0% vs 12.5%, P =.015) was more frequent in patients, while decreased high-density lipoprotein cholesterol was more frequent in controls (32.5% vs 19.0%, P =.032). Family history of type 2 diabetes mellitus was associated with increased body mass index (BMI) zscore (P <.001), WC zscore (P =.001), insulin (P =.038), and homeostatic model assessment of insulin resistance (HOMA-IR; P =.025). Dyslipidemia was associated with significantly increased insulin (P =.041), HOMA-IR (P =.032), and low-density lipoprotein cholesterol (P =.041). Previous antipsychotic exposure was not associated with increased cardiometabolic risk. Early age at onset predicted increased BMI and WC z scores, while diagnosis of schizophrenia and higher Clinical Global Impression-Severity score were associated with increased blood lipids. Conclusions: Youths with FEP had significantly greater WC and lipid abnormalities than matched controls, regardless of antipsychotic exposure. In youths with FEP, elevated metabolic risk predates antipsychotic exposure.

AB - Objective: To describe pretreatment cardiometabolic constitution in children and adolescents with first-episode psychosis (FEP). Methods: Baseline cardiometabolic assessment was performed in youths aged 12-17 years with FEP entering the Tolerability and Efficacy of Antipsychotics (TEA) trial and matched healthy controls. Patients were included between June 10, 2010, and January 29, 2014. ICD-10 was used as the diagnostic classification system. Cardiometabolic risk markers were compared between patients versus controls and antipsychotic-naive versus antipsychotic-exposed patients. Results: Comparing 113 youths with FEP (age ± SD = 15.74 ± 1.36 years, males = 30.1%, schizophrenia-spectrum disorders = 92.9%, antipsychoticnaive: n = 57) to 60 controls, patients had higher waist circumference (WC) zscores (1.13 ± 1.65 vs 0.42 ± 1.27, P =.018), cholesterol (4.10 ± 0.71 vs 3.79 ± 0.49 mmol/L, P =.014), low-density lipoproteins (2.37 ± 0.56 vs 2.13 ± 0.51, P =.012), and non-high-density lipoproteins (2.58 ± 1.60 vs 2.52 ± 0.52, P =.018). More patients than controls (42.9% vs 20.3%, P =.019) and antipsychotic-naive than antipsychotic-exposed (51.9% vs 34.0%, P =.023) had a WC > 90th percentile. Hypercholesterolemia (34.0% vs 12.5%, P =.015) was more frequent in patients, while decreased high-density lipoprotein cholesterol was more frequent in controls (32.5% vs 19.0%, P =.032). Family history of type 2 diabetes mellitus was associated with increased body mass index (BMI) zscore (P <.001), WC zscore (P =.001), insulin (P =.038), and homeostatic model assessment of insulin resistance (HOMA-IR; P =.025). Dyslipidemia was associated with significantly increased insulin (P =.041), HOMA-IR (P =.032), and low-density lipoprotein cholesterol (P =.041). Previous antipsychotic exposure was not associated with increased cardiometabolic risk. Early age at onset predicted increased BMI and WC z scores, while diagnosis of schizophrenia and higher Clinical Global Impression-Severity score were associated with increased blood lipids. Conclusions: Youths with FEP had significantly greater WC and lipid abnormalities than matched controls, regardless of antipsychotic exposure. In youths with FEP, elevated metabolic risk predates antipsychotic exposure.

U2 - 10.4088/JCP.15m10479

DO - 10.4088/JCP.15m10479

M3 - Journal article

C2 - 28102978

AN - SCOPUS:85026676723

SN - 0160-6689

VL - 78

SP - e1035-e1046

JO - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

IS - 8

ER -