- Email: [email protected]
P.3.c.053 Lithium-neuroleptic neurotoxicity, delirious-extrapyramidal reactions, and neuroleptic malignant syndrome
S540
P.3.c Psychotic disorders and antipsychotics - Antipsychotics (clinical)
within 4 weeks. Results presented are the lowest value (in the case of blood pressure) or the mean of the two measurements (all other results). Results: Out of the 204 patients, 67 refused participation. The population of the participating 137 patients were 48 years old, Caucasian (92%), male (66%) and overweight (28.6). The majority of the patients (71%) suffered from a psychotic disorder, 12% from a bipolar disorder and the other 17% from different disorders. The metabolic syndrome was present in 55% of the patients, which greatly exceeds the prevalence of 23% in a recent study (2007) in the general Dutch population of comparable age. Conclusions: With 66% of the patients participating, metabolic screening in outpatients suffering from severe mental illnesses is feasible. Compared to the rate of participation and/or the percentage of screened patients, both before and after the publication of the APA-screening guidelines and before and after team intervention, this study with a designate nurse practitioner showed a substantially higher participation rate. These results suggest that standardised metabolic screening in SMI in outpatient FACT-care is both feasible and necessary. However, improvement strategy to further increase the participation rate, possibly toe 95%-100%, remains highly desirable.
patients with bipolar disorder and there was no other group difference in components of metabolic syndrome. The prevalence of metabolic syndrome was 27.6% in patients with bipolar disorder and 33.6% in patients with schizophrenia. There was no significant difference between two diagnostic groups but both groups had almost twice as high prevalence of metabolic syndrome than the reference group(17.9%). The mean values of all criteria of metabolic syndrome except systolic blood pressure were significantly different between both diagnostic groups and the reference group. In patients with schizophrenia and the reference group, metabolic syndrome was significantly more prevalent in men than women. However in patients with bipolar disorder, there was no gender difference in prevalence of metabolic syndrome. There was no difference of prevalence of metabolic syndrome according to medication group in both diagnostic groups. Conclusion: Bipolar disorder is also as prone to metabolic syndrome as schizophrenia in the Korean population. The prevalence of metabolic syndrome in both patients is almost twofold higher than that of reference group. Further research on risk factors with a large population-based prospective study may lead to better understanding and prevention of metabolic syndrome in patients with schizophrenia and bipolar disorder.
References
Ip.3.c.0521 Higher prevalence of metabolic syndrome in patient with bipolar disorder and schizophrenia in Korean population N.Y. Lee!", H.Y. Yu2 , D.C. Jung", S.H. Kim 2 , Y.S. Kim 2 , Y.M. Ahn 2 . 1Seoul National University, Biomedical Science, Seoul, South-Korea; 2Seoul National University Hospital, Neuropsychiatry, Seoul, South-Korea Objective: It is well established that metabolic syndrome are more common in patients with schizophrenia than the general population, but it is unclear whether patients with bipolar disorder also have a higher prevalence of metabolic syndrome. In addition, there is limited data about the prevalence of bipolar disorder compared with schizophrenia in Asian counties. This study was conducted to examine the prevalence of metabolic syndrome in the Korean sample with bipolar disorder and schizophrenia and to draw comparisons with a reference group. Methods: We selected eligible patients by reviewing medical records of patients with diagnosis of bipolar disorder and schizophrenia in a university hospital psychiatric clinic in Seoul, Korea. The age- and sex-matched reference data were extracted from records of Health Promotion Centre of the same hospital. We assessed the metabolic syndrome according to the guidelines of the Adapted National Cholesterol Education Program Adult Treatment Panel III, with modified waist circumference criteria for Asian-Pacific region by WHO. The prevalence of metabolic syndrome of the two diagnostic groups was compared with each other and to that of the reference group. Results: Medical records of 152 subject with bipolar disorder and 271 with schizophrenia were analyzed. Sex distribution, mean age, and mean duration of illness and treatment were not different between diagnostic groups. In patients with bipolar disorder, 33% were treated with antipsychotics only, 12% mood stabilizer only and 56% with combination of them. Ninety two percents of patients with schizophrenia were treated with antipsychotics only and the others with combination of antipsychotics and mood stabilizer. The mean values of fasting blood glucose and triglycerides were higher in patients with schizophrenia than in
[I] Correll CU, Frederickson AM, Kane JM, Manu P. Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics. Bipolar disord. 2008; I 0(7):788-797 [2] Grundy SM, Cleeman n, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith Jr SC, Spertus JA, Costa F. Diagoosis and management of the metabolic syndrome: an American Heart National Heart, Lung, and Blood Institute Scientific statement. Circulation. 2005; 112 (17): 2735-52 [3] Salvi V, Albert U, chizrle A, soreca I, Bogetto F, Maina G. Metabolic syndrome in Italian patients with bipolar disorder. General Hospital Psychiatry. 2008;30:318-323
IP.3.c.0531 Lithium-neuroleptic neurotoxicity, deliriousextrapyramidal reactions, and neuroleptic malignant syndrome
IW. Lee 1 '. 1 Graylands Hospital & School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia Objectives: A neurotoxic syndrome with delirium and various extrapyramidal symptoms has been sparsely reported in association with lithium-neuroleptic combination therapy. A severe form of this neurotoxic syndrome with fever and autonomic disturbance closely resembles neuroleptic malignant syndrome (NMS); cases of this hyperthermic delirious-extrapyramidal syndrome have often been included in review studies of NMS. A delirious-extrapyramidal syndrome without fever has also been reported associated with the use of neuroleptics alone. It is unclear if the delirious-extrapyramidal syndrome is a distinct neurotoxic reaction, a transitional stage in the progression to NMS, or a variant of NMS. This study intends to examine: (a) the clinical presentations of the delirious-extrapyramidal syndrome associated with combined lithium-neuroleptic therapy and with neuroleptic therapy, and (b) the hypothesis that the delirious-extrapyramidal syndrome and NMS are disorders on the same spectrum. Methods: Seventeen episodes (psychiatric diagnoses: 7 mania, 1 mixed mood state, 9 schizophrenia) with concurrent delirium and severe extrapyramidal symptoms developed during treatment
P.3.c Psychotic disorders and antipsychotics - Antipsychotics (clinical) with neuroleptic medications or lithium-neuroleptic combinations were identified. They fulfilled the DSM IV diagnostic criteria for delirium and neuroleptic-induced movement disorders. No fever or prominent autonomic abnormality was noted at the time of diagnosis of the delirious extrapyramidal syndrome. The severity of delirium was assessed using the Delirium Rating Scale. They were managed as clinically indicated. Their progress was closely monitored. The delirious extrapyramidal episodes were analysed noting the various extrapyramidal syndromes, associated neurological symptoms, laboratory findings, and progression of symptoms in these episodes. The clinical presentations of episodes associated with lithium-neuroleptic combination therapy were compared with those associated with neuroleptic therapy. Results: (a) Seven episodes were associated with lithiumneuroleptic combinations and 10 with neuroleptic therapy. (b) Neuroleptic medications: 12 conventional (5 with concurrent lithium), 4 risperidone (1 with lithium), 1 olanzapine (with lithium). (c) Extrapyramidal syndromes: 8 parkinsonian, 4 parkinsonian-dystonic, 1 parkinsonian-dystonic-akathisic, 1 dystonic, 1 dystonic-akathisic, 1 acute dyskinesic (choreoathetotic). (d) Associated neurological symptoms included ataxia (6), dysarthria (7), dysphagia (4), and incontinence (5). e) The clinical presentations were similar in those associated with lithiumneuroleptic and those with neuroleptic therapy (f) In 6 episodes extrapyramidal symptoms :first developed, followed by the emergence of delirium. (e). In 5 episodes (4 lithium-neuroleptic) the delirious extrapyramidal syndrome progressed to NMS with appearance ofhyperthermia and autonomic disturbances. (e). Most of the non-NMS episodes resolved promptly with discontinuation of the offending neuroleptics. Two episodes that progressed to NMS were treated with amantadine or bromocriptine with prompt resolution of symptoms. Conclusion: Lithium-neuroleptic combinations and neuroleptics may induce a delirious-extrapyramidal syndrome similar in clinical presentations. The observed progression in some cases from extrapyramidal syndrome to a delirious extrapyramidal syndrome, and from the delirious extrapyramidal syndrome to NMS supports the hypothesis that extrapyramidal side effects, delirious extrapyramidal reactions, and NMS are disorders on the same spectrum, and the delirious-extrapyraidal reaction may be regarded as a variant or precursor ofNMS. References
[1] Cohen WJ, Cohen NH., 1974, Lithium carbonate, haloperidol, and irreversible brain damage, JAMA, 230, 1283-1287. [2] Dowling JJ, Patrick v., 1989, Delirium with dystonia: a variant of neuroleptic malignant syndrome, Am J Psychiatry, 146,276-7. [3] Lee JW., 2007, Catatonic variants, hyperthermic extrapyramidal reactions, and subtypes of neuroleptic malignant syndrome, Annals of Clinical Psychiatry, 19(1), 9-16.
Ip.3.c.0541 Effect of diagnosis and treatment on cardiometabolic risk in community psychiatric patients
P. Mackin1 ., A. Nulkar1, H.M.a. Watkinson1 , A. Waton 1 . 1 Institute of Neuroscience, Psychiatry, Newcastle upon lJme, United Kingdom Introduction: Much of the literature reporting an association between mental illness and cardio-metabolic disease is based on studies of patients with schizophrenia or major mood disorders. Little is known about the prevalence of physical co-morbidity
S541
on other diagnostic groups. Similarly, reports of the deleterious effects of psychotropic medication arise from studies of patients with schizophrenia; the contribution of drugs to cardiovascular risk in other diagnostic groups is not well understood. Purpose of the study: To investigate the effects of diagnosis and psychotropic medication on cardio-metabolic risk factors in community psychiatric patients in North Tyneside with those of the local population. Methods: Physical health clinics have been established in North Tyneside to conduct annual health checks for community psychiatric patients. Demographic data, smoking status, dietary intake, exercise, anthropometric measures, blood pressure, diagnoses, psychotropic medications and dose were recorded. An ECG was performed. Data on cardio-metabolic risk factors (e.g. body mass index (BMI), waist.hip ratio, blood pressure, glycaemic status, lipid profile, and 10-year Framingham cardiovascular risk scores) are reported. We compared cardio-metabolic risk profiles across diagnostic groups, and examined the relationship between cardiometabolic risk and psychotropic medication. Results: Data from 319 patients who received annual health checks between January 2008 and February 2009 are presented. Fifty-three per cent of the sample (n = 170) was male; mean age was 47.1 (± 11.9) years, and the sample was predominantly White British (98.4%, n=314). Age, gender, smoking status, BMI and waist.hip ratio were significantly different across diagnostic groups (see table). Other cardio-metabolic risk factors, or the presence of cardiovascular disease did not differ between diagnostic groups. Antipsychotic (AP) drugs were prescribed in 74.8% (typical = 9.1%; atypical = 61.8%; combination = 3.8%); antidepressants in 59.0%; mood stabilisers in 31.9%. There was a significant relationship between cardio-metabolic risk and antipsychotic use (combination AP > atypical AP > typical AP > no AP) for waist.hip ratio (0.99, 0.94, 0.91, 0.89; p=O.OOl) and lO-yr CV risk % (15.7,11.0,9.4,7.4; p=O.Ol).
Age, years (±SD) Gender, % m:f smoker, % BMI, kgm-2 (±SD) W;H ratio (±SD) Diabetes, % MetSyn, % IO-y CV risk, % (±SD) Antipsychotic, %
Psychotic disorders (n= 119)
Mood disorders (n= 167)
Anxiety disorders (n=l1)
Personality p value disorders (n=20)
48.0 (11.2) 68:32 50.0 30.5 (5.4) 0.96 (0.10) 14.3 49.5 10.5 (6.7) 98.3
48.2 (13.2) 47:53 37.6 29.7 (5.9) 0.91 (0.09) 9.0 39.1 10.5 (9.3) 61.7
43.3 (13.2) 46:54 54.5 28.7 (6.4) 0.92 (0.11) 9.1 12.5 8.1 (7.9) 63.6
36.3 (10.5) 30:70 60.0 35.7 (12.4) 0.87 (0.10) 5.0 47.1 5.6 (5.6) 50.0
<0.001 <0.001 0.07 0.001 <0.001 0.73 0.13 0.29 <0.001
Conclusion: Community psychiatric patients have a high burden of cardio-metabolic risk, and this risk does not appear to be greater in any diagnostic sub-group. Antipsychotic use is significantly related to increased cardiovascular risk independently of diagnosis. All patients in contact with mental health services should be considered 'high risk' with regard to the development of cardiovascular disease, and in particular those treated with antipsychotic drugs.
P.3.c Psychotic disorders and antipsychotics - Antipsychotics (clinical)
within 4 weeks. Results presented are the lowest value (in the case of blood pressure) or the mean of the two measurements (all other results). Results: Out of the 204 patients, 67 refused participation. The population of the participating 137 patients were 48 years old, Caucasian (92%), male (66%) and overweight (28.6). The majority of the patients (71%) suffered from a psychotic disorder, 12% from a bipolar disorder and the other 17% from different disorders. The metabolic syndrome was present in 55% of the patients, which greatly exceeds the prevalence of 23% in a recent study (2007) in the general Dutch population of comparable age. Conclusions: With 66% of the patients participating, metabolic screening in outpatients suffering from severe mental illnesses is feasible. Compared to the rate of participation and/or the percentage of screened patients, both before and after the publication of the APA-screening guidelines and before and after team intervention, this study with a designate nurse practitioner showed a substantially higher participation rate. These results suggest that standardised metabolic screening in SMI in outpatient FACT-care is both feasible and necessary. However, improvement strategy to further increase the participation rate, possibly toe 95%-100%, remains highly desirable.
patients with bipolar disorder and there was no other group difference in components of metabolic syndrome. The prevalence of metabolic syndrome was 27.6% in patients with bipolar disorder and 33.6% in patients with schizophrenia. There was no significant difference between two diagnostic groups but both groups had almost twice as high prevalence of metabolic syndrome than the reference group(17.9%). The mean values of all criteria of metabolic syndrome except systolic blood pressure were significantly different between both diagnostic groups and the reference group. In patients with schizophrenia and the reference group, metabolic syndrome was significantly more prevalent in men than women. However in patients with bipolar disorder, there was no gender difference in prevalence of metabolic syndrome. There was no difference of prevalence of metabolic syndrome according to medication group in both diagnostic groups. Conclusion: Bipolar disorder is also as prone to metabolic syndrome as schizophrenia in the Korean population. The prevalence of metabolic syndrome in both patients is almost twofold higher than that of reference group. Further research on risk factors with a large population-based prospective study may lead to better understanding and prevention of metabolic syndrome in patients with schizophrenia and bipolar disorder.
References
Ip.3.c.0521 Higher prevalence of metabolic syndrome in patient with bipolar disorder and schizophrenia in Korean population N.Y. Lee!", H.Y. Yu2 , D.C. Jung", S.H. Kim 2 , Y.S. Kim 2 , Y.M. Ahn 2 . 1Seoul National University, Biomedical Science, Seoul, South-Korea; 2Seoul National University Hospital, Neuropsychiatry, Seoul, South-Korea Objective: It is well established that metabolic syndrome are more common in patients with schizophrenia than the general population, but it is unclear whether patients with bipolar disorder also have a higher prevalence of metabolic syndrome. In addition, there is limited data about the prevalence of bipolar disorder compared with schizophrenia in Asian counties. This study was conducted to examine the prevalence of metabolic syndrome in the Korean sample with bipolar disorder and schizophrenia and to draw comparisons with a reference group. Methods: We selected eligible patients by reviewing medical records of patients with diagnosis of bipolar disorder and schizophrenia in a university hospital psychiatric clinic in Seoul, Korea. The age- and sex-matched reference data were extracted from records of Health Promotion Centre of the same hospital. We assessed the metabolic syndrome according to the guidelines of the Adapted National Cholesterol Education Program Adult Treatment Panel III, with modified waist circumference criteria for Asian-Pacific region by WHO. The prevalence of metabolic syndrome of the two diagnostic groups was compared with each other and to that of the reference group. Results: Medical records of 152 subject with bipolar disorder and 271 with schizophrenia were analyzed. Sex distribution, mean age, and mean duration of illness and treatment were not different between diagnostic groups. In patients with bipolar disorder, 33% were treated with antipsychotics only, 12% mood stabilizer only and 56% with combination of them. Ninety two percents of patients with schizophrenia were treated with antipsychotics only and the others with combination of antipsychotics and mood stabilizer. The mean values of fasting blood glucose and triglycerides were higher in patients with schizophrenia than in
[I] Correll CU, Frederickson AM, Kane JM, Manu P. Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics. Bipolar disord. 2008; I 0(7):788-797 [2] Grundy SM, Cleeman n, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith Jr SC, Spertus JA, Costa F. Diagoosis and management of the metabolic syndrome: an American Heart National Heart, Lung, and Blood Institute Scientific statement. Circulation. 2005; 112 (17): 2735-52 [3] Salvi V, Albert U, chizrle A, soreca I, Bogetto F, Maina G. Metabolic syndrome in Italian patients with bipolar disorder. General Hospital Psychiatry. 2008;30:318-323
IP.3.c.0531 Lithium-neuroleptic neurotoxicity, deliriousextrapyramidal reactions, and neuroleptic malignant syndrome
IW. Lee 1 '. 1 Graylands Hospital & School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia Objectives: A neurotoxic syndrome with delirium and various extrapyramidal symptoms has been sparsely reported in association with lithium-neuroleptic combination therapy. A severe form of this neurotoxic syndrome with fever and autonomic disturbance closely resembles neuroleptic malignant syndrome (NMS); cases of this hyperthermic delirious-extrapyramidal syndrome have often been included in review studies of NMS. A delirious-extrapyramidal syndrome without fever has also been reported associated with the use of neuroleptics alone. It is unclear if the delirious-extrapyramidal syndrome is a distinct neurotoxic reaction, a transitional stage in the progression to NMS, or a variant of NMS. This study intends to examine: (a) the clinical presentations of the delirious-extrapyramidal syndrome associated with combined lithium-neuroleptic therapy and with neuroleptic therapy, and (b) the hypothesis that the delirious-extrapyramidal syndrome and NMS are disorders on the same spectrum. Methods: Seventeen episodes (psychiatric diagnoses: 7 mania, 1 mixed mood state, 9 schizophrenia) with concurrent delirium and severe extrapyramidal symptoms developed during treatment
P.3.c Psychotic disorders and antipsychotics - Antipsychotics (clinical) with neuroleptic medications or lithium-neuroleptic combinations were identified. They fulfilled the DSM IV diagnostic criteria for delirium and neuroleptic-induced movement disorders. No fever or prominent autonomic abnormality was noted at the time of diagnosis of the delirious extrapyramidal syndrome. The severity of delirium was assessed using the Delirium Rating Scale. They were managed as clinically indicated. Their progress was closely monitored. The delirious extrapyramidal episodes were analysed noting the various extrapyramidal syndromes, associated neurological symptoms, laboratory findings, and progression of symptoms in these episodes. The clinical presentations of episodes associated with lithium-neuroleptic combination therapy were compared with those associated with neuroleptic therapy. Results: (a) Seven episodes were associated with lithiumneuroleptic combinations and 10 with neuroleptic therapy. (b) Neuroleptic medications: 12 conventional (5 with concurrent lithium), 4 risperidone (1 with lithium), 1 olanzapine (with lithium). (c) Extrapyramidal syndromes: 8 parkinsonian, 4 parkinsonian-dystonic, 1 parkinsonian-dystonic-akathisic, 1 dystonic, 1 dystonic-akathisic, 1 acute dyskinesic (choreoathetotic). (d) Associated neurological symptoms included ataxia (6), dysarthria (7), dysphagia (4), and incontinence (5). e) The clinical presentations were similar in those associated with lithiumneuroleptic and those with neuroleptic therapy (f) In 6 episodes extrapyramidal symptoms :first developed, followed by the emergence of delirium. (e). In 5 episodes (4 lithium-neuroleptic) the delirious extrapyramidal syndrome progressed to NMS with appearance ofhyperthermia and autonomic disturbances. (e). Most of the non-NMS episodes resolved promptly with discontinuation of the offending neuroleptics. Two episodes that progressed to NMS were treated with amantadine or bromocriptine with prompt resolution of symptoms. Conclusion: Lithium-neuroleptic combinations and neuroleptics may induce a delirious-extrapyramidal syndrome similar in clinical presentations. The observed progression in some cases from extrapyramidal syndrome to a delirious extrapyramidal syndrome, and from the delirious extrapyramidal syndrome to NMS supports the hypothesis that extrapyramidal side effects, delirious extrapyramidal reactions, and NMS are disorders on the same spectrum, and the delirious-extrapyraidal reaction may be regarded as a variant or precursor ofNMS. References
[1] Cohen WJ, Cohen NH., 1974, Lithium carbonate, haloperidol, and irreversible brain damage, JAMA, 230, 1283-1287. [2] Dowling JJ, Patrick v., 1989, Delirium with dystonia: a variant of neuroleptic malignant syndrome, Am J Psychiatry, 146,276-7. [3] Lee JW., 2007, Catatonic variants, hyperthermic extrapyramidal reactions, and subtypes of neuroleptic malignant syndrome, Annals of Clinical Psychiatry, 19(1), 9-16.
Ip.3.c.0541 Effect of diagnosis and treatment on cardiometabolic risk in community psychiatric patients
P. Mackin1 ., A. Nulkar1, H.M.a. Watkinson1 , A. Waton 1 . 1 Institute of Neuroscience, Psychiatry, Newcastle upon lJme, United Kingdom Introduction: Much of the literature reporting an association between mental illness and cardio-metabolic disease is based on studies of patients with schizophrenia or major mood disorders. Little is known about the prevalence of physical co-morbidity
S541
on other diagnostic groups. Similarly, reports of the deleterious effects of psychotropic medication arise from studies of patients with schizophrenia; the contribution of drugs to cardiovascular risk in other diagnostic groups is not well understood. Purpose of the study: To investigate the effects of diagnosis and psychotropic medication on cardio-metabolic risk factors in community psychiatric patients in North Tyneside with those of the local population. Methods: Physical health clinics have been established in North Tyneside to conduct annual health checks for community psychiatric patients. Demographic data, smoking status, dietary intake, exercise, anthropometric measures, blood pressure, diagnoses, psychotropic medications and dose were recorded. An ECG was performed. Data on cardio-metabolic risk factors (e.g. body mass index (BMI), waist.hip ratio, blood pressure, glycaemic status, lipid profile, and 10-year Framingham cardiovascular risk scores) are reported. We compared cardio-metabolic risk profiles across diagnostic groups, and examined the relationship between cardiometabolic risk and psychotropic medication. Results: Data from 319 patients who received annual health checks between January 2008 and February 2009 are presented. Fifty-three per cent of the sample (n = 170) was male; mean age was 47.1 (± 11.9) years, and the sample was predominantly White British (98.4%, n=314). Age, gender, smoking status, BMI and waist.hip ratio were significantly different across diagnostic groups (see table). Other cardio-metabolic risk factors, or the presence of cardiovascular disease did not differ between diagnostic groups. Antipsychotic (AP) drugs were prescribed in 74.8% (typical = 9.1%; atypical = 61.8%; combination = 3.8%); antidepressants in 59.0%; mood stabilisers in 31.9%. There was a significant relationship between cardio-metabolic risk and antipsychotic use (combination AP > atypical AP > typical AP > no AP) for waist.hip ratio (0.99, 0.94, 0.91, 0.89; p=O.OOl) and lO-yr CV risk % (15.7,11.0,9.4,7.4; p=O.Ol).
Age, years (±SD) Gender, % m:f smoker, % BMI, kgm-2 (±SD) W;H ratio (±SD) Diabetes, % MetSyn, % IO-y CV risk, % (±SD) Antipsychotic, %
Psychotic disorders (n= 119)
Mood disorders (n= 167)
Anxiety disorders (n=l1)
Personality p value disorders (n=20)
48.0 (11.2) 68:32 50.0 30.5 (5.4) 0.96 (0.10) 14.3 49.5 10.5 (6.7) 98.3
48.2 (13.2) 47:53 37.6 29.7 (5.9) 0.91 (0.09) 9.0 39.1 10.5 (9.3) 61.7
43.3 (13.2) 46:54 54.5 28.7 (6.4) 0.92 (0.11) 9.1 12.5 8.1 (7.9) 63.6
36.3 (10.5) 30:70 60.0 35.7 (12.4) 0.87 (0.10) 5.0 47.1 5.6 (5.6) 50.0
<0.001 <0.001 0.07 0.001 <0.001 0.73 0.13 0.29 <0.001
Conclusion: Community psychiatric patients have a high burden of cardio-metabolic risk, and this risk does not appear to be greater in any diagnostic sub-group. Antipsychotic use is significantly related to increased cardiovascular risk independently of diagnosis. All patients in contact with mental health services should be considered 'high risk' with regard to the development of cardiovascular disease, and in particular those treated with antipsychotic drugs.