Mark Livingston

Lifestyle factors and the metabolic syndrome in Schizophrenia: a cross-sectional study

BackgroundCardiometabolic disease is more common in patients with schizophrenia than the general population.AimThe purpose of the study was to assess lifestyle factors, including diet and exercise, in patients with schizophrenia and estimate the prevalence of metabolic syndrome.MethodsThis is a cross-sectional study of a representative group of outpatients with schizophrenia in Salford, UK. An interview supplemented by questionnaires was used to assess diet, physical activity, and cigarette and alcohol use. Likert scales assessed subjects’ views of diet and activity. A physical examination and relevant blood tests were conducted.ResultsThirty-seven people were included in the study. 92% of men had central adiposity, as did 91.7% of women (International Diabetes Federation Definition). The mean age was 46.2xa0years and mean illness duration was 11.6xa0years. 67.6% fulfilled criteria for the metabolic syndrome. The mean number of fruit and vegetable portions per day was 2.8xa0±xa01.8. Over a third did not eat any fruit in a typical week. 42% reported doing no vigorous activity in a typical week. 64.9% smoked and in many cigarette use was heavy. The Likert scale showed that a high proportion of patients had insight into their unhealthy lifestyles.ConclusionsWithin this sample, there was a high prevalence of poor diet, smoking and inadequate exercise. Many did not follow national recommendations for dietary intake of fruit and vegetables and daily exercise. These factors probably contribute to the high prevalence of metabolic syndrome. Many had insight into their unhealthy lifestyles. Thus, there is potential for interventions to improve lifestyle factors and reduce the risk of cardiometabolic disease.

Sex differences in plasma clozapine and norclozapine concentrations in clinical practice and in relation to body mass index and plasma glucose concentrations: a retrospective survey

BackgroundClozapine is widely prescribed and, although effective, can cause weight gain and dysglycemia. The dysmetabolic effects of clozapine are thought to be more prevalent in women with this gender on average attaining 17xa0% higher plasma clozapine concentrations than men.MethodsWe investigated the relationship between dose, body mass index (BMI), plasma glucose concentration, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in 100 individuals with a severe enduringxa0mental illness.ResultsMean (10th/90th percentile) plasma clozapine concentrations were higher for women [0.49 (0.27–0.79) mg/L] compared with men [0.44 (0.26–0.70) mg/L] (Fxa0=xa02.2; pxa0=xa00.035). There was no significant gender difference in the prescribed clozapine dose. BMI was significantly higher in women [mean (95xa0% CI)xa0=xa034.5 (26.0–45.3)] for females compared with 32.5 (25.2–41.0) for males. Overall, BMI increased by 0.7xa0kg/m2 over a mean follow-up period of 210xa0days. A lower proportion, 41xa0% of women had a fasting blood glucose ≤6.0xa0mmol/L (<6.0xa0mmol/L is defined by the International Diabetes Federation as normal glucose handling), compared with 88xa0% of men (χ2xa0=xa018.6, pxa0<xa00.0001).ConclusionsWe have shown that mean BMI and blood glucose concentrations are higher in women prescribed clozapine than in men. Women also tended to attain higher plasma clozapine concentrations than men. The higher BMI and blood glucose in women may relate to higher tissue exposure to clozapine, as a consequence of sex differences in drug metabolism.

Route to improving Type 1 diabetes mellitus glycaemic outcomes: real‐world evidence taken from the National Diabetes Audit

To use general practice‐level data for England, available through the National Diabetes Audit, and primary care prescribing data to identify prescription treatment factors associated with variations in achieved glucose control (HbA1c).

Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study:

Background: Diabetes, obesity and metabolic syndrome are highly prevalent in patients with severe mental illness and can impose a major physical health burden. Objective: To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with Severe Mental Illness living in Cheshire, UK. Methods: In all, 1307 individuals on the severe mental illness Register were followed up between 2002 and 2012 in UK general practice. Subjects were identified through a pseudanonymised search of general practice registers. Results: Baseline body mass index was 28.6u2009kg/m2 increasing to 31.0 at 10-year follow-up (r2u2009=u20090.84; pu2009=u20090.0002). There was a significant increase in fasting blood glucose from 5.72 to 6.79u2009mmol/L (r2u2009=u20090.48; pu2009=u20090.026). Correspondingly, there was a strong positive univariate relation between increase in body mass index and fasting blood glucose (r2u2009=u20090.54; pu2009<u20090.0001) taking into account all measurements. Fasting blood glucose also increased slightly with age (pu2009=u20090.028). With increasing use of statins, total cholesterol fell from 4.5 to 3.9u2009mmol/L (r2u2009=u20090.88; pu2009=u20090.0001), as did low-density lipoprotein cholesterol from 3.43 to 2.35u2009mmol/L (r2u2009=u20090.94; pu2009=u20090.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in body mass index (odds ratiou2009=u20091.07 [1.01, 1.13]; pu2009=u20090.031) and triglycerides (odds ratiou2009=u20091.28 (1.06, 1.55); pu2009=u20090.009) was independently associated with an increased risk of having type 2 diabetes. Conclusion: Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.

Serum testosterone levels in male hypogonadism: Why and when to check-A review

Although “late onset hypogonadism”, a condition that includes low testosterone and symptoms, is common in men over the age of 40 years, diagnosis is not clear cut amongst non‐specialists. It is the aim of this review to provide an up to date picture of how this state should be diagnosed and managed.

Measuring vitamin D levels: surrogates are insufficient.

With the increasing evidence of adverse consequences because of low vitamin D levels on health demand for vitamin D, screening is increasing.

Improving Type 2 Diabetes Mellitus glycaemic outcomes is possible without spending more on medication: Lessons from the UK National Diabetes Audit

To determine the factors at general practice level that relate to glycaemic control outcomes in people with type 2 diabetes (T2DM).

Prescribing in schizophrenia and psychosis: Increasing polypharmacy over time

Diabetes, obesity, and metabolic syndrome are highly prevalent in patients with severe mental illness. Psychotropic polypharmacy is becoming increasingly prevalent within the UK. We determined the change in the number of psychotropic medications prescribed over time and trends in weight and fasting blood glucose.

No difference in mood and quality of life in DHEA-S deficient adults with Addison's disease vs. Type 2 diabetes patients with normal DHEA-S levels: Implications for management of these conditions

Patients with Addison’s disease have relatively high rates of depression and anxiety symptoms compared with population-based reference samples. Addison’s disease results in deficiency of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S). There is considerable debate about the specific effects of DHEA deficiency on energy level and mood. We measured emotional well-being in 16 patients with Addison’s disease and a group of 16 hospital attendees with type 2 diabetes. Participants completed the General Health Questionnaire-28 (GHQ-28), the Hospital Anxiety and Depression Scale (HADS), the World Health Organization’s quality of life assessment (WHOQOL-BREF) and the Holmes–Rahe life event scale. DHEA-S was low in Addison’s patients (Addison’s men: 0.5 ± 0.1 μmol/l [normal range: 2.1–10.8] compared with diabetes men: 3.2 ± 1.2 μmol/l; Addison’s women: 0.4 ± 0.01 μmol/l [normal range: 1.0–11.5] compared with diabetes women: 2.2 ± 0.71 μmol/l). Testosterone levels were similar in both groups studied. There were no differences in emotional well-being and quality of life (QOL) between patients with Addison’s disease and Type 2 Diabetes Mellitus as measured by GHQ-28 (Addison’s: 22.4 ± 2.6, Diabetes: 19.6 ± 2.7), HADS Depression (Addison’s: 5.4 ± 0.9, Diabetes: 4.5 ± 1.4), HADS Anxiety and WHOQOL-BREF. There were no gender differences in affective symptomatology within the Addison’s group. Life event scores were above average in both groups (Addison’s: 195 ± 39.6, Diabetes: 131 ± 43.8), but not significant for difference between groups as was GHQ-28 total score. Both groups scored highly on the GHQ-28 and the life event scale, indicative of poorer health perceptions than the general population. This could be due to the chronicity of both disorders. We have not identified any specific effects of DHEA-S deficiency on mood or QOL.

Monitoring Thyroid Function in Patients on Levothyroxine. Assessment of Conformity to National Guidance and Variability in Practice

With demand for endocrine tests steadily increasing year-on-year, we examined thyroid function test (TFT) frequencies in patients on levothyroxine replacement therapy to assess the effect of initial TFT results and request source on TFT re-testing interval. All TFTs performed by the Clinical Biochemistry Departments at the Salford Royal Hospital (2009-2012; 288u2009263 requests from 139u2009793 patients) and University Hospital of North Midlands (2011-2014; 579u2009156 requests from 193u2009035 patients) were extracted from the laboratory computer systems. Of these, 54u2009894 tests were on 13u2009297 patients confirmed to be on levothyroxine therapy in the test cohort (Salford) and 67u2009298 requests on 11u2009971 patients in the confirmatory cohort (North Midlands). In the test cohort, median TFT re-testing interval in the total group was 19.1 weeks (IQR 9.1-37.7 weeks), with clearly defined peaks in TFT re-testing evident at 6 and 12 months and a prominent broad peak at 1-3 months. Median re-test interval was much lower than recommended (52 weeks) for those with normal TFTs at 31.3 weeks (30.6 weeks for the confirmatory cohort). Where thyroid-stimulating hormone (TSH) was elevated and free thyroxine (fT4) was below the reference range, re-test interval was much longer than is recommended (8 weeks) at 13.4-17.6 weeks (7.1-23.4 weeks in the confirmatory cohort), as was the interval when TSH was below and fT4 was above the normal range, at 16.7-25.6 weeks (27.5-31.9 weeks in the confirmatory cohort). Our findings show that the majority of TFT requests are requested outside recommended intervals and within-practice variability is high. A new approach to ensuring optimum monitoring frequency is required. Direct requesting from the clinical laboratory may provide one such solution.