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Letters to the Editor   |    
Bipolar Disorder, Schizophrenia, and Metabolic Syndrome
Francesco Bartoli, M.D., Ph.D.; Giuseppe Carrà, M.D., M.Sc., Ph.D.; Cristina Crocamo, M.Sc.; Daniele Carretta, M.D.; Massimo Clerici, M.D., Ph.D.
Am J Psychiatry 2013;170:927-928. doi:10.1176/appi.ajp.2013.13040447
View Author and Article Information

The authors report no financial relationships with commercial interests.

From the Department of Surgery and Interdisciplinary Medicine, University of Milan Bicocca, Milan, Italy; the Mental Health Sciences Unit, Faculty of Brain Sciences, University College London; and the Department of Mental Health, San Gerardo Hospital, Monza, Italy.

Copyright © 2013 by the American Psychiatric Association

Accepted June , 2013.

To the Editor: In the March issue, Vancampfort et al. (1) reported valuable data by conducting a meta-analysis of published studies on rates of metabolic syndrome among people with bipolar disorder. In the general findings paragraph, they also compared prevalence of metabolic syndrome among different psychiatric disorders. Rates appeared to be significantly higher in bipolar patients, 37.3% (95% confidence interval [CI]=36.1–39.0), than in schizophrenia patients, 32.5% (95% CI=30.1–35.0) (2). The authors advised caution in interpreting this finding because of the lack of data allowing direct comparison between individuals with schizophrenia and bipolar disorder. However, we believe that this is an important issue that should be more thoroughly assessed and commented on. Among articles screened for suitability for inclusion in meta-analysis, 11 provided data on metabolic syndrome prevalence rates of 3,888 unique participants: 1,572 with bipolar disorder and 2,316 with schizophrenia. Therefore, there may well be sufficient data for a supplementary analysis assessing differences on metabolic syndrome rates between these diagnostic subgroups.

A pooled analysis based on a random-effects model and using odds ratio as an association measure is depicted in Figure 1. The number of individuals with metabolic syndrome was 705 among bipolar patients and 890 among schizophrenia patients. The pooled odds ratio (bipolar compared with schizophrenia) was 1.01 (95% CI=0.82–1.24; p=0.93), with low heterogeneity across the studies (I2=31%; p=0.15). In addition, a subanalysis based on four studies reporting significantly higher rates of antipsychotic prescriptions in people with schizophrenia revealed a similar chance of metabolic syndrome for individuals with bipolar disorder (odds ratio=0.98, 95% CI=0.70–1.38; p=0.91). Further subanalyses did not reveal any statistical difference. We believe these findings may well complement those reported by Vancampfort et al. (1). Individuals with bipolar disorder and schizophrenia have comparable chances of having metabolic syndrome. Despite important differences in clinical features, these individuals may actually share a number of health behaviors, including poor physical activity, unhealthy diet, excessive alcohol intake, and smoking habits. Future research should assess the relative contribution to metabolic syndrome not only of different psychiatric diagnoses, but also of components such as genetics, antipsychotic medication use, lifestyle, and health behaviors.

 
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FIGURE 1.Association Estimate for Metabolic Syndrome in Bipolar Disorder Compared With Schizophrenia and Other Psychotic Disorders
Vancampfort  D;  Vansteelandt  K;  Correll  CU;  Mitchell  AJ;  De Herdt  A;  Sienaert  P;  Probst  M;  De Hert  M:  Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators.  Am J Psychiatry 2013; 170:265–274
[CrossRef] | [PubMed]
 
Mitchell  AJ;  Vancampfort  D;  Sweers  K;  van Winkel  R;  Yu  W;  De Hert  M:  Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders: a systematic review and meta-analysis.  Schizophr Bull 2013; 39:306–318
[CrossRef] | [PubMed]
 
Baptista  T;  Serrano  A;  Uzcátegui  E;  ElFakih  Y;  Rangel  N;  Carrizo  E;  Fernández  V;  Connell  L;  de Baptista  EA;  Quiroz  S;  Uzcátegui  M;  Rondón  J;  Matos  Y;  Uzcátegui  L;  Gómez  R;  Valery  L;  Novoa-Montero  D:  The metabolic syndrome and its constituting variables in atypical antipsychotic-treated subjects: comparison with other drug treatments, drug-free psychiatric patients, first-degree relatives and the general population in Venezuela.  Schizophr Res 2011; 126:93–102
[CrossRef] | [PubMed]
 
Birkenaes  AB;  Opjordsmoen  S;  Brunborg  C;  Engh  JA;  Jonsdottir  H;  Ringen  PA;  Simonsen  C;  Vaskinn  A;  Birkeland  KI;  Friis  S;  Sundet  K;  Andreassen  OA:  The level of cardiovascular risk factors in bipolar disorder equals that of schizophrenia: a comparative study.  J Clin Psychiatry 2007; 68:917–923
[CrossRef] | [PubMed]
 
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; 10:788–797
[CrossRef] | [PubMed]
 
Holt  RI;  Abdelrahman  T;  Hirsch  M;  Dhesi  Z;  George  T;  Blincoe  T;  Peveler  RC:  The prevalence of undiagnosed metabolic abnormalities in people with serious mental illness.  J Psychopharmacol 2010; 24:867–873
[CrossRef] | [PubMed]
 
John  AP;  Koloth  R;  Dragovic  M;  Lim  SC:  Prevalence of metabolic syndrome among Australians with severe mental illness.  Med J Aust 2009; 190:176–179
[PubMed]
 
Khatana  SA;  Kane  J;  Taveira  TH;  Bauer  MS;  Wu  WC:  Monitoring and prevalence rates of metabolic syndrome in military veterans with serious mental illness.  PLoS One 2011; 6:e19298
[CrossRef] | [PubMed]
 
Mattoo  SK;  Singh  SM:  Prevalence of metabolic syndrome in psychiatric inpatients in a tertiary care centre in north India.  Indian J Med Res 2010; 131:46–52
[PubMed]
 
Sicras-Mainar  A;  Blanca-Tamayo  M;  Rejas-Gutiérrez  J;  Navarro-Artieda  R:  Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a cross-sectional assessment of a primary health care database.  Eur Psychiatry 2008; 23:100–108
[CrossRef] | [PubMed]
 
Teixeira  PJ;  Rocha  FL:  The prevalence of metabolic syndrome among psychiatric inpatients in Brazil:  Rev Bras Psiquiatr . 2007; 29:330–336
[CrossRef] | [PubMed]
 
van Winkel  R;  van Os  J;  Celic  I;  Van Eyck  D;  Wampers  M;  Scheen  A;  Peuskens  J;  De Hert  M:  Psychiatric diagnosis as an independent risk factor for metabolic disturbances: results from a comprehensive, naturalistic screening program.  J Clin Psychiatry 2008; 69:1319–1327
[CrossRef] | [PubMed]
 
Vuksan-Ćusa  B;  Jakovljević  M;  Sagud  M;  Mihaljević  Peleš A;  Marčinko  D;  Topić  R;  Mihaljević  S;  Sertić  J:  Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with second generation antipsychotics.  Psychiatry Res 2011; 189:21–25
[CrossRef] | [PubMed]
 
References Container

FIGURE 1. Association Estimate for Metabolic Syndrome in Bipolar Disorder Compared With Schizophrenia and Other Psychotic Disorders
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References

Vancampfort  D;  Vansteelandt  K;  Correll  CU;  Mitchell  AJ;  De Herdt  A;  Sienaert  P;  Probst  M;  De Hert  M:  Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators.  Am J Psychiatry 2013; 170:265–274
[CrossRef] | [PubMed]
 
Mitchell  AJ;  Vancampfort  D;  Sweers  K;  van Winkel  R;  Yu  W;  De Hert  M:  Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders: a systematic review and meta-analysis.  Schizophr Bull 2013; 39:306–318
[CrossRef] | [PubMed]
 
Baptista  T;  Serrano  A;  Uzcátegui  E;  ElFakih  Y;  Rangel  N;  Carrizo  E;  Fernández  V;  Connell  L;  de Baptista  EA;  Quiroz  S;  Uzcátegui  M;  Rondón  J;  Matos  Y;  Uzcátegui  L;  Gómez  R;  Valery  L;  Novoa-Montero  D:  The metabolic syndrome and its constituting variables in atypical antipsychotic-treated subjects: comparison with other drug treatments, drug-free psychiatric patients, first-degree relatives and the general population in Venezuela.  Schizophr Res 2011; 126:93–102
[CrossRef] | [PubMed]
 
Birkenaes  AB;  Opjordsmoen  S;  Brunborg  C;  Engh  JA;  Jonsdottir  H;  Ringen  PA;  Simonsen  C;  Vaskinn  A;  Birkeland  KI;  Friis  S;  Sundet  K;  Andreassen  OA:  The level of cardiovascular risk factors in bipolar disorder equals that of schizophrenia: a comparative study.  J Clin Psychiatry 2007; 68:917–923
[CrossRef] | [PubMed]
 
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; 10:788–797
[CrossRef] | [PubMed]
 
Holt  RI;  Abdelrahman  T;  Hirsch  M;  Dhesi  Z;  George  T;  Blincoe  T;  Peveler  RC:  The prevalence of undiagnosed metabolic abnormalities in people with serious mental illness.  J Psychopharmacol 2010; 24:867–873
[CrossRef] | [PubMed]
 
John  AP;  Koloth  R;  Dragovic  M;  Lim  SC:  Prevalence of metabolic syndrome among Australians with severe mental illness.  Med J Aust 2009; 190:176–179
[PubMed]
 
Khatana  SA;  Kane  J;  Taveira  TH;  Bauer  MS;  Wu  WC:  Monitoring and prevalence rates of metabolic syndrome in military veterans with serious mental illness.  PLoS One 2011; 6:e19298
[CrossRef] | [PubMed]
 
Mattoo  SK;  Singh  SM:  Prevalence of metabolic syndrome in psychiatric inpatients in a tertiary care centre in north India.  Indian J Med Res 2010; 131:46–52
[PubMed]
 
Sicras-Mainar  A;  Blanca-Tamayo  M;  Rejas-Gutiérrez  J;  Navarro-Artieda  R:  Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a cross-sectional assessment of a primary health care database.  Eur Psychiatry 2008; 23:100–108
[CrossRef] | [PubMed]
 
Teixeira  PJ;  Rocha  FL:  The prevalence of metabolic syndrome among psychiatric inpatients in Brazil:  Rev Bras Psiquiatr . 2007; 29:330–336
[CrossRef] | [PubMed]
 
van Winkel  R;  van Os  J;  Celic  I;  Van Eyck  D;  Wampers  M;  Scheen  A;  Peuskens  J;  De Hert  M:  Psychiatric diagnosis as an independent risk factor for metabolic disturbances: results from a comprehensive, naturalistic screening program.  J Clin Psychiatry 2008; 69:1319–1327
[CrossRef] | [PubMed]
 
Vuksan-Ćusa  B;  Jakovljević  M;  Sagud  M;  Mihaljević  Peleš A;  Marčinko  D;  Topić  R;  Mihaljević  S;  Sertić  J:  Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with second generation antipsychotics.  Psychiatry Res 2011; 189:21–25
[CrossRef] | [PubMed]
 
References Container
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