Metabolic syndrome in relation to psychotropic polypharmacy

Objective: To assess the prevalence of metabolic syndrome (MetS) in psychiatric outpatients with a diagnosis of psychotic spectrum disorders and to investigate whether antipsychotic polypharmacy and concomitant use of mood stabilizers, antidepressants or both is associated with an increased prevalence of MetS and its parameters. Method: Over a period of 32 months, male and female patients aged at least 18 year and receiving treatment with one or more antipsychotic agent, were consecutively recruited from the outpatient departments and classified according to DSM-IV criteria. A diagnosis of MetS was made following the NCEP-ATP-III guidelines. Apart from antipsychotics, the concomitant use of mood stabilizers and antidepressants was recorded. Results: A total of 543 patients, mean age and duration of disease 43 and 14 years respectively, were included. The majority had a diagnosis of psychotic spectrum disorder whereas ten percent was diagnosed with affective spectrum disorder. Most patients were on antipsychotic monotherapy. Concomitant treatment with mood stabilizing agents and/or antidepressants was present in 43 percent of the patients. MetS was diagnosed in about half of the patients. No relationship with antipsychotic polypharmacy could be established, neither with the class of antipsychotic agent. Prevalence of MetS increased significantly in patients comedicated with mood stabilizing agents, antidepressants or both, especially in females. Conclusions: MetS is present in about half of the patients treated with antipsychotics and is associated with mood stabilizing and/or antidepressant comedication. Adequate somatic treatment strategies are warranted to reduce the risk of cardiovascular diseases at relatively young age.