Skip to main content Accessibility help
×
Home

Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study

  • Fiona Gaughran (a1), Daniel Stahl (a2), Dominic Stringer (a3), David Hopkins (a4), Zerrin Atakan (a5), Kathryn Greenwood (a6), Anita Patel (a7), Shubulade Smith (a8), Poonam Gardner-Sood (a9), John Lally (a10), Margaret Heslin (a11), Brendon Stubbs (a12), Stefania Bonaccorso (a13), Anna Kolliakou (a14), Oliver Howes (a15), David Taylor (a16), Marta Di Forti (a17), Anthony S. David (a18), Robin M. Murray (a19), Khalida Ismail (a20) and the IMPACT team (a1) (a2) (a4) (a3) (a5) (a6) (a7) (a8) (a9) (a10) (a11) (a12) (a13) (a14) (a15) (a16) (a17) (a18) (a19) (a20)...

Abstract

Background

The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.

Aims

We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.

Method

This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.

Results

Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).

Conclusions

Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.

Declaration of interest

F.G. has received honoraria for advisory work and lectures or CME activity support from Roche, BMS, Lundbeck, Otsuka, Janssen and Sunovion, is a collaborator on an NHS Innovations project co-funded by Janssen and has a family member with professional links to Lilly and GSK, including shares. R.M.M. has received honoraria for lectures from Lundbeck, Otsuka, Janssen and Sunovian. M.D.F. has received honoraria for lectures from Janssen and Sunovian. Z.A. has received honoraria for advisory work and lectures from Roche, Sanofi, Lilly and Otsuka. O.H. has received investigator-initiated research funding from and/or participated in advisory/speaker meetings organised by Astra-Zeneca, Autifony, Biogen, BMS, Eli Lilly, Heptares, Jansenn, Lundbeck, Lyden-Delta, Otsuka, Servier, Sunovion, Rand and Roche. D.T. has received funding for lectures and research from Janssen, Otsuka, Servier, Lundbeck, Sunovion.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.

Corresponding author

Correspondence: Fiona Gaughran, W1.08, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London SE5 8AF, UK. Email: Fiona.p.gaughran@kcl.ac.uk

Footnotes

Hide All
*

These authors contributed equally to the work as first authors.

These authors contributed equally to the work as last authors.

Members of the IMPACT team are listed in the Acknowledgements.

Footnotes

References

Hide All
1Olfson, M, Gerhard, T, Huang, C, Crystal, S, Stroup, TS. Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 2015; 72: 1172–81.
2Pillinger, T, Beck, K, Gobjila, C, Donocik, JG, Jauhar, S, Howes, OD. Impaired glucose homeostasis in first-episode schizophrenia: a systematic review and meta-analysis. JAMA Psychiatry 2017; 74: 261–9.
3Fleischhacker, WW, Siu, CO, Bodén, R, Pappadopulos, E, Karayal, ON, Kahn, RS. Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial. Int J Neuropsychopharmacol 2013; 16: 987–95.
4Howes, O, Bhatnagar, A, Gaughran, F, Amiel, S, Pilowsky, L, Murray, R. A prospective study of changes in glucose control caused by clozapine without changes in insulin resistance. Am J Psychiatry 2004; 161: 361–3.
5Tek, C, Kucukgoncu, S, Guloksuz, S, Woods, SW, Srihari, VH, Annamalai, A. Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications. Early Interv Psychiatry 2016; 10: 193202.
6Nyboe, L, Vestergaard, CH, Moeller, MK, Lund, H, Videbech, P. Metabolic syndrome and aerobid fitness in patients with first episode schizophrenia, including a 1-year follow-up. Schizophr Res 2015; 168(1–2): 381–7.
7World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
8Craddock, N, Asherson, P, Owen, MJ, Williams, J, McGuffin, P, Farmer, AE. Concurrent validity of the OPCRIT diagnostic system. Comparison of OPCRIT diagnoses with consensus best-estimate lifetime diagnoses. Br J Psychiatry 1996; 169: 5863.
9Kay, SR, Fiszbein, A, Opler, LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76.
10Richard, CW, Hall, MD. Global assessment of functioning: a modified scale. Psychosomatics 1995; 36: 267–75.
11Guy, W. Clinical Global Impressions (CGI) Scale, Modified. In Task Force for the Handbook of Psychiatric Measures. Handbook of Psychiatric Measures (1st edn) (ed Rush, JA). American Psychiatric Association, 2000.
12Addington, D, Addington, J, Schissel, B. A depression rating scale for schizophrenics. Schizophr Res 1990; 3: 247–51.
13Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978; 133: 429–35.
14World Health Organization. Overweight and Obesity in Adults. WHO, 2015 (http://www.who.int/healthinfo/indicators/2015/chi_2015_67_adults_overweight.pdf?ua=).
15American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care 2017; 40 (suppl 1): 1142.
16Alberti, KG, Zimmet, P, Shaw, J. Metabolic syndrome–a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006; 23: 469–80.
17Craig, CL, Marshall, AL, Sjöström, M, Bauman, AE, Booth, ML, Ainsworth, BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381–95.
18Faulkner, G, Cohn, T, Remington, G. Validation of a physical activity assessment tool for individuals with schizophrenia. Schizophr Res 2006; 82: 225–31.
19Roe, L, Strong, C, Whiteside, C, Neil, A, Mant, D. Dietary intervention in primary care: validity of the DINE method for diet assessment. Fam Pract 1994; 11: 375–81.
20Fagerstrom, KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav 1978; 3: 235–41.
21Saunders, J, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction 1993; 88: 791804.
22Di Forti, M, Morgan, C, Dazzan, P, Pariante, C, Mondelli, V, Marques, TR, et al. High-potency cannabis and the risk of psychosis. Br J Psychiatry 2009; 195: 488–91.
23Barkus, EJ, Stirling, J, Hopkins, RS, Lewis, S. Cannabis-induced psychosis-like experiences are associated with high schizotypy. Psychopathology 2006; 39: 175–8.
24White, IR, Daniel, R, Royston, P. Avoiding bias due to perfect prediction in multiple imputation of incomplete categorical data. Comput Stat Data Anal 2010; 54: 2267–75.
25Schencker, N, Taylor, JMG. Partially parametric techniques for multiple imputation. Comput Stat Data Anal 1996; 22: 425–46.
26Lang, TA, Secic, M. How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers (2nd edn). American College of Physician Press, 2006.
27Bray, GA, Kim, KK, Wilding, JPH. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev 2017; 18: 715–23.
28Curtis, J, Watkins, A, Rosenbaum, S, Teasdale, S, Kalucy, M, Samaras, K, et al. Evaluating an individualized lifestyle and life skills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis. Early Interv Psychiatry 2016; 10: 267–76.
29Dickerson, F, Stallings, C, Origoni, A, Schroeder, J, Khushalani, S, Yolken, R. Mortality in schizophrenia: clinical and serological predictors. Schizophr Bull 2014; 40: 796803.
30Colizzi, M, Carra, E, Fraietta, S, Lally, J, Quattrone, D, Bonaccorso, S, et al. Substance use, medication adherence and outcome one year following a first episode of psychosis. Schizophr Res 2016; 170: 311–7.
31Robson, D, Spaducci, G, McNeill, A, Stewart, D, Craig, TJK, Yates, M, et al. Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis. Lancet Psychiatry 2017; 4: 540–6.
32Gilbody, S, Peckham, E, Bailey, D, Arundel, C, Heron, P, Crosland, S, et al. Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial. Lancet Psychiatry 2019; 6: 379–90.
33Stubbs, B, Williams, J, Gaughran, F, Craig, T. How sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr Res 2016; 171: 103–9.
34World Health Organization. Physical Activity and Adults. WHO, accessed 2019 (https://www.who.int/dietphysicalactivity/factsheet_adults/en/).
35Stubbs, B, Gardner-Sood, P, Smith, S, Ismail, K, Greenwood, K, Farmer, R, et al. Sedentary behaviour is associated with elevated C-reactive protein levels in people with psychosis. Schizophr Res 2015; 168: 461–4.
36Vepsäläinen, T, Soinio, M, Marniemi, J, Lehto, S, Juutilainen, A, Laakso, M, et al. Physical activity, high-sensitivity C-reactive protein, and total and cardiovascular disease mortality in type 2 diabetes. Diabetes Care 2011; 34: 1492–6.
37Williams, J, Stubbs, B, Gaughran, F, Craig, T. ‘Walk This Way’ - a pilot of a health coaching intervention to reduce sedentary behaviour and increase low intensity exercise in people with serious mental illness: study protocol for a randomised controlled trial. Trials 2016; 17: 594.
38Buchanan, RW, Kreyenbuhl, J, Kelly, DL, Noel, JM, Boggs, DL, Fischer, BA, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull; 2010; 36: 7193.
39Howes, OD, Vergunst, F, Gee, S, McGuire, P, Kapur, S, Taylor, D. Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation. Br J Psychiatry 2012; 201: 481–5.
40Lally, J, Ajnakina, O, Di Forti, M, Trotta, A, Demjaha, A, Kolliakou, A, et al. Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses. Psychol Med 2016; 46: 3231–40.
41Gardner-Sood, P, Lally, J, Smith, S, Atakan, Z, Ismail, K, Greenwood, KE, et al. Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial. Psychol Med 2015; 45: 2619–29.
42Goh, LG, Dhaliwal, SS, Welborn, TA, Lee, AH, Della, PR. Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study. BMJ Open 2014; 4: e004138.
43Das-Munshi, J, Chang, CK, Dutta, R, Morgan, C, Nazroo, J, Stewart, R, et al. Ethnicity and excess mortality in severe mental illness: a cohort study. Lancet Psychiatry 2017; 4: 389–99.
44Stevens, J, Keil, JE, Rust, PF, Tyroler, HA, Davis, CE, Gazes, PC. Body mass index and body girths as predictors of mortality in black and white women. Arch Intern Med 1992; 152: 1257–62.
45National Institute for Health and Care Excellence. Type 2 Diabetes: Prevention in People at High Risk. NICE, 2012 ((https://www.nice.org.uk/guidance/PH38/chapter/Recommendations#risk-identification-stage-1).
46Das-Munshi, J, Ashworth, M, Dewey, ME, Gaughran, F, Hull, S, Morgan, C, et al. Type 2 diabetes mellitus in people with severe mental illness: inequalities by ethnicity and age. Cross-sectional analysis of 588 408 records from the UK. Diabet Med 2017; 34: 916–24.
47Stuart, EA, Azur, M, Frangakis, C, Leaf, P. Multiple imputation with large data sets: a case study of the Children's Mental Health Initiative. Am J Epidemiol 2009; 169: 1133–9.

Keywords

Type Description Title
WORD
Supplementary materials

Gaughran et al. supplementary material
Tables S1-S7

 Word (62 KB)
62 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study

  • Fiona Gaughran (a1), Daniel Stahl (a2), Dominic Stringer (a3), David Hopkins (a4), Zerrin Atakan (a5), Kathryn Greenwood (a6), Anita Patel (a7), Shubulade Smith (a8), Poonam Gardner-Sood (a9), John Lally (a10), Margaret Heslin (a11), Brendon Stubbs (a12), Stefania Bonaccorso (a13), Anna Kolliakou (a14), Oliver Howes (a15), David Taylor (a16), Marta Di Forti (a17), Anthony S. David (a18), Robin M. Murray (a19), Khalida Ismail (a20) and the IMPACT team (a1) (a2) (a4) (a3) (a5) (a6) (a7) (a8) (a9) (a10) (a11) (a12) (a13) (a14) (a15) (a16) (a17) (a18) (a19) (a20)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *