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BACKGROUND: Guidelines on laboratory screening in schizophrenia recommend annual monitoring of fasting lipids and glucose. The utility and the cost effectiveness of more extensive laboratory screening have not been studied. METHODS: The Living Conditions and the Physical Health of Outpatients with Schizophrenia Study provided a comprehensive health examination, including a laboratory test panel for 275 participants. We calculated the prevalence of the results outside the reference range for each laboratory test, and estimated the cost effectiveness to find an aberrant test result using the number needed to screen to find one abnormal result (NNSAR) and the direct cost spent to find one abnormal result (DCSAR, NNSAR x direct cost per test) formulas. In addition, we studied whether patients who were obese or used clozapine had more often abnormal results. RESULTS: A half of the sample had 25-hydroxyvitamin D below, and almost one-fourth cholesterol, triglycerides or glucose above the reference range. One-fifth had sodium below and gamma glutamyltransferase above the reference range. NNSAR was highest for potassium (137) and lowest for 25-hydroxyvitamin D (2). DCSAR was below 5 for glucose, all lipids and sodium, and below 10 for creatinine and gamma glutamyltransferase. Potassium (130), pH-adjusted ionized calcium (33 ) and thyroid stimulating hormone (33) had highest DCSARs. Several abnormal results were more common in obese and clozapine using patients. CONCLUSIONS: An annual laboratory screening panel for an outpatient with schizophrenia should include fasting glucose, lipids, sodium, creatinine, a liver function test and complete blood count, and preferably 25-hydroxyvitamin D.
RESUMO
OBJECTIVE: To determine the prevalence of metabolic syndrome and investigate its components in individuals with psychotic disorders and individuals using antipsychotic medication in a general population study. METHOD: The study population was a nationally representative, 2-stage cluster sample of 8028 persons aged 30 years or over from Finland. The field work for this study took place between September 2000 and June 2001. Laboratory and other measurements related to metabolic syndrome were taken in a health examination. We used the Structured Clinical Interview for DSM-IV (SCID-I) and case note data when making diagnostic assessments according to DSM-IV-TR criteria. Metabolic syndrome was diagnosed according to Adult Treatment Panel III criteria. Subjects who had not fasted the required 4 hours were excluded from the analysis. Prevalences of metabolic syndrome, adjusting for age, sex, and hours of fasting, were estimated by calculating predicted marginals, evaluated at 8 hours of fasting. RESULTS: The prevalence estimates of metabolic syndrome were 36.2% (SE = 7.3), 41.4% (SE = 6.3), and 25.0% (SE = 8.6) among subjects with schizophrenia, other nonaffective psychosis, and affective psychosis, respectively, compared with 30.1% (SE = 0.8) in subjects without psychotic disorders. Subjects with schizophrenia had significantly lower high-density lipoprotein cholesterol and higher tri-glyceride and glucose levels and larger waist circumference, but also lower systolic blood pressure, than the remaining study population (all p values < .05). While all markers of metabolic syndrome were elevated among subjects with other nonaffective psychotic disorders, only the difference in waist circumference was statistically significant (p < .05). The prevalence of metabolic syndrome was significantly elevated among users of high-potency (52.1% [SE = 6.6]; p < .001) but not low-potency (39.0% [SE = 6.9]) and atypical (23.4% [SE = 10.8]) antipsychotic medication. CONCLUSION: Nonaffective psychotic disorders are associated with abdominal obesity and glucose and lipid abnormalities. Regular monitoring and active treatment of metabolic abnormalities are essential in this patient population.