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ORIGINAL ARTICLE
Year : 2016  |  Volume : 7  |  Issue : 1  |  Page : 62-67  

Metabolic syndrome in patients with severe mental illness in Gorgan


1 Department of Psychiatry, Golestan Research Center of Psychiatry, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
2 Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
3 Department of Psychiatry, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
4 Education Development Center, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
5 Department of Biochemistry and Biophysics, Metabolic Disorders Research Center, Gorgan Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran

Date of Web Publication28-Jan-2016

Correspondence Address:
Abdoljalal Marjani
Department of Biochemistry and Biophysics, Metabolic Disorders Research Center, Gorgan Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan Province
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-9668.175073

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   Abstract 

Background: Metabolic syndrome is commonly associated with cardiovascular diseases and psychiatric mental illness. Hence, we aimed to assess the metabolic syndrome among severe mental illness (SMI). Materials and Methods: The study included 267 patients who were referred to the psychiatric unit at 5 th Azar Education Hospital of Golestan University of Medical Sciences in Gorgan, Iran. Results: The mean waist circumference, systolic and diastolic blood pressure, triglyceride and fasting blood glucose levels were significantly higher in the SMI with metabolic syndrome, but the high density lipoprotein (HDL)-cholesterol was significantly lower. The prevalence of metabolic syndrome in SMI patients was 20.60%. There were significant differences in the mean of waist circumference, systolic (except for women) and diastolic blood pressure, triglyceride, HDL-cholesterol and fasting blood glucose in men and women with metabolic syndrome when compared with subjects without metabolic syndrome. The prevalence of metabolic syndrome in SMI women was higher than men. The most age distribution was in range of 30-39 years old. The most prevalence of metabolic syndrome was in age groups 50-59 years old. The prevalence of metabolic syndrome was increased from 30 to 59 years old. Conclusion: The prevalence of metabolic syndrome in patients with SMI in Gorgan is almost similar to those observed in Asian countries. The prevalence of metabolic syndrome was lower than western countries. These observations may be due to cultural differences in the region. It should be mention that the families of mental illness subjects in our country believe that their patients must be cared better than people without mental illness. These findings of this study suggest that mental illness patients are at risk of metabolic syndrome. According to our results, risk factors such as age and gender differences may play an important role in the presence of metabolic syndrome. In our country, women do less physical activity than men; therefore, the incidence of metabolic syndrome is higher among women.

Keywords: Gorgan, metabolic syndrome, severe mental illness


How to cite this article:
Kamkar MZ, Sanagoo A, Zargarani F, Jouybari L, Marjani A. Metabolic syndrome in patients with severe mental illness in Gorgan. J Nat Sc Biol Med 2016;7:62-7

How to cite this URL:
Kamkar MZ, Sanagoo A, Zargarani F, Jouybari L, Marjani A. Metabolic syndrome in patients with severe mental illness in Gorgan. J Nat Sc Biol Med [serial online] 2016 [cited 2020 Aug 4];7:62-7. Available from: http://www.jnsbm.org/text.asp?2016/7/1/62/175073


   Introduction Top


Metabolic syndrome is a cluster of risk factors for some diseases such as cardiovascular disease (CVD) and type 2 diabetes. According to the adult treatment panel (ATP III) criteria, any three of the five components are necessary for the diagnosis of metabolic syndrome: Elevated waist circumference, blood pressure, serum triglyceride and glucose and reduced high-density lipoprotein (HDL) cholesterol. [1] Metabolic syndrome is associated with CVD and psychiatric mental illness. [2],[3],[4],[5] Some studies have shown the relationship between metabolic syndrome and coronary artery diseases in different ethnic groups, gender, age, and postmenopausal women. [6],[7],[8],[9],[10],[11],[12] Several studies in Europe have reported 28-37% prevalence of metabolic syndrome with mental illness such as schizophrenia. [13],[14],[15],[16] Many other studies indicated 43% and 46% prevalence of metabolic syndrome in the United States and Canada respectively. [17],[18] Incidentally, people with psychiatric diseases such as schizophrenia have lower life expectancy than people without mental illness and subjects with coronary artery diseases. [19] Metabolic syndrome is reported in 19-63%, 42.4%, 12-36%, and 8-56% patients with schizophrenia, schizoaffective psychosis, relapsing depression, and bipolar affective disorder, respectively. [20],[21],[22],[23] Studies on patients with severe mental health have shown that males and females schizophrenic patients have 138% and 251% more chance to have metabolic syndrome than general populations. [17] Individuals with severe mental illnesses (SMI) show a higher prevalence of metabolic syndrome than those who do not a metabolic syndrome. [24],[25] These people indicate an important social and/or occupational dysfunction. [26] The elevated prevalence of metabolic syndrome in these subjects may be related to the disease itself, treatment with the antipsychotic drug, obesity, consumption of high-fat diets, low physical activity, and active smoking. [27] Patients with SMI die earlier than the general population. Premature deaths prevalence among these subjects varies between 80% and 95%. [28] Studies have shown that individuals with metabolic syndrome have 4 and 3 times more risk of developing diabetes and coronary heart disease, respectively. [12],[29] Metabolic syndrome is a complex disease. Prognosis of this disease is poor and needs specific attention to control. The prevalence of metabolic syndrome among psychiatric disorders patients has been rarely studied. The aim of the present study was to assess the metabolic syndrome among patients with SMI in Gorgan (South East of Caspian Sea, Iran).


   Materials and methods Top


267 patients with SMI, aged 18-73 years (mean age 38.93 ± 10.79 years) who were treated with antipsychotic drugs and referred to the psychiatric unit at 5 th Azar Education Hospital of Gorgan Faculty of Medicine, Golestan University of Medical Sciences in Gorgan, Iran in 2014. SMI patients were defined if they are in the following category: Schizophrenia, bipolar 1 mood disorder, major depressive disorder with psychotic features, psychotic or mood disorder in association with a general medical condition and schizoaffective disorder. SMI patients were diagnosed by a psychologist. We excluded patients without complete information, pregnant, substance abuse, anxiety disorders, mental retarded, and Axis II disorders.

A 10 ml blood samples were collected after an overnight fast of 12 h. Serum fasting blood glucose, HDL-cholesterol, total cholesterol and triglyceride levels were determined with commercial kits by spectrophotometer techniques (Model JENWAY 6105 UV/VIS) in the Metabolic Disorders Research Center. The Friedewald equation was used to calculate low density lipoprotein cholesterol (LDL-cholesterol) level. Weight was measured, while subjects were minimally clothed without shoes, using digital scales. Height was measured in standing position using tape meter while the shoulder was in a normal position. Body mass index (BMI) was defined as weight in kilograms divided by height in meters squared. Overweight was defined as BMI 25.0-29.9 kg/m 2 and obese as BMI ≥30 kg/m 2 . [30] Waist circumferences were measured at the point halfway between the lower border of ribs and the iliac crest in a horizontal plane. [31] Systolic and diastolic blood pressure was measured in sitting position from the right hand. Metabolic syndrome identified if SMI patients had any three or more of the following criteria, according to the ATP III [1] as it has shown in [Table 1].
Table 1: Risk factors for the metabolic syndrome according to ATP III

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This study was approved by the Research Deputy Ethics Committee of the Golestan University of Medical Sciences. The results are revealed as means and standard deviations and percentages. A software system SPSS for Windows (version 16.0, SPSS Inc., Chicago, Illinois, USA) was used to calculate the statistical analysis. The evaluation of results was carried out using independent sample t-test and Chi-squared test. A P < 0.05 was considered as statistically significant.


   Results Top


The present study assessed 267 patients with SMI. The mean age of the subjects was 38.90 ± 0.66 years. [Table 2] shows the biochemical data of the subjects with and without the metabolic syndrome in patients with SMI. The mean waist circumference, systolic and diastolic blood pressure, triglyceride and fasting blood glucose levels were significantly higher in the SMI with metabolic syndrome, but the mean HDL-cholesterol was significantly lower (P < 0.05). The prevalence of metabolic syndrome in SMI was 20.60%. [Table 3] and [Table 4] show biochemical data of SMI men and women with and without metabolic syndrome. There were significant differences in the mean of waist circumference, systolic (except for women) and diastolic blood pressure, triglyceride, HDL-cholesterol and fasting blood glucose in men and women with metabolic syndrome when compared with subjects without metabolic syndrome (P < 0.05). There were no significant differences in total cholesterol and LDL-cholesterol. The prevalence of metabolic syndrome in SMI women (32%) was higher than men (13.77%). [Table 5] shows the distribution of different age groups in patients with SMI with and without metabolic syndrome. The most age distribution was in the range of 30-39 years old. The most prevalence of metabolic syndrome was in age groups 50-59 years old. The prevalence of metabolic syndrome was increased from 30 to 59 years old.
Table 2: Biochemical characteristic of SMI with and without metabolic syndrome

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Table 3: Biochemical characteristic of SMI in men with and without metabolic syndrome

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Table 4: Biochemical characteristic of SMI in women with and without metabolic syndrome

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Table 5: Distribution of different age groups in SMI with and without metabolic syndrome

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   Discussion Top


Our study showed a low prevalence of metabolic syndrome (20.60%) in patients with SMI according to the ATP III criteria. Several studies have assessed whether an increased prevalence of the metabolic syndrome is prevalent among patients with SMI in comparison to the general population. Studies showed that prevalence of metabolic syndrome was estimated to be 60% and 75% among schizophrenic and mood disorder patients, respectively. [32] Recent studies of Heiskanen et al. indicated that prevalence of metabolic syndrome in patients with schizophrenia was 37% in comparison to the general population. [16] Many other studies have reported prevalence of metabolic syndrome changes in patients with SMI in different populations such as Hong Kong (35%), USA (28.7-60%), Australia (54%), Canada (44.7%) and Finland (37.1%). [16],[18],[33],[34],[35],[36] Interestingly Asian population show a lower prevalence of metabolic syndrome in patients with SMI than Western populations. Studies on Taiwan and Thailand populations indicated that prevalence of metabolic syndrome in schizophrenia patients was 22% and 20%, respectively. [37],[38] Our results show that the prevalence of metabolic syndrome in patients with SMI in Gorgan is lower than western populations [16],[18],[34],[35],[36] and almost similar to some other Asian countries. [37],[38] Study of McEvoy et al., in the USA showed that elevated risk of metabolic syndrome in patients with SMI to be 138% and 251% for males and females, respectively. [17] The results of this study demonstrate that lifestyle of patients with SMI in Gorgan are not the same as the western countries. Many studies have shown that unhealthy lifestyle and poor diet of these patients have an important role in etiology of the metabolic syndrome. [2],[39] SMI patients are at risk for metabolic syndrome, therefore, should be screened and identify to prevent probable future type 2 diabetes mellitus and CVDs. SMI show 2-3 times the incidence of higher type 2 diabetes mellitus and CVDs than the general population. [25] A recent study in the USA indicated that all CVDs risk factors such as central obesity, hypertension, dyslipidemia, and hyperglycemia were higher in SMI than in the general population. [40] Study of Lozano et al. [41] revealed that deaths due to diabetes and CVDs are estimated to increases by 2020. [41] The prevalence of metabolic syndrome in our sample of patients with SMI is lower than North American [17],[18] and European studies, [13],[14],[15],[16] these differences may be due to geographic differences. The lower prevalence of metabolic syndrome in these patients proposed that differences in lifestyle factors might decrease susceptibility to metabolic syndrome in this area when it is compared to other populations. The influence of lifestyle factors such as physical activity and diet were not evaluated in this study. The 20.60% prevalence of metabolic syndrome is lower than the study from Australia (68%). [42] The prevalence of metabolic syndrome in mental patients in Gorgan deserves more attention from health service providers. Elevated mortality is reported from psychiatric disorders such as schizoaffective, bipolar, and depressive disorders. [43],[44],[45] In our study, the prevalence of metabolic syndrome was lower than some other studies in patients with bipolar disorder and psychotic depression. [44],[46],[47],[48] Our results suppose that psychiatric illness should be taking into account a risk factor for metabolic syndrome, which makes it necessary to screen people with any psychiatric disorder. [49] The variation of metabolic syndrome prevalence among SMI were seen mostly in ages 50-59 years old in comparison to other age groups. Our results were not in agreement with some other studies. [3],[4],[17],[18] Our findings indicated that metabolic syndrome among these patients differs significantly from ages 30 up to 59 years old. In our study, the prevalence of metabolic syndrome was different between genders, which is in agreement with the findings of other studies. [1],[3],[4],[5],[13],[14],[15],[16],[17],[18],[42],[43],[49],[50],[51],[52],[53] The onset of metabolic syndrome from an early age may increase the risk of CVDs in SMI. Cardiovascular risk factors treatment should be considered the main care in people with mental disorders in addition to screening for CVD risk factors.


   Conclusion Top


Our results show that the prevalence of metabolic syndrome in patients with SMI in Gorgan is almost similar to those observed in Asian countries. The prevalence of metabolic syndrome was lower than western countries. These observations may be due to cultural differences in the region. It should be mention that the families of mental illness subjects in our country believe that their patients must be cared better than people without mental illness. These findings of this study suggest that mental illness patients are at risk of metabolic syndrome. According to our results, risk factors such as age and gender differences may play an important role in the presence of metabolic syndrome. In our country, women do less physical activity than men. Hence, the incidence of metabolic syndrome may be higher among women.

Acknowledgments

The authors thank from Research Deputy of Golestan University of Medical Sciences for financial support of this study.

Financial support and sponsorship

Research Deputy of Golestan University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.  Back to cited text no. 1
    
2.
Hennekens CH. Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia. J Clin Psychiatry 2007;68 Suppl 4:4-7.  Back to cited text no. 2
    
3.
Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28.  Back to cited text no. 3
    
4.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.  Back to cited text no. 4
    
5.
Meyer J, Koro CE, L›Italien GJ. The metabolic syndrome and schizophrenia: A review. Int Rev Psychiatry 2005;17:173-80.  Back to cited text no. 5
    
6.
Marjani A, Hezarkhani S, Shahini N. Prevalence of Metabolic syndrome among fars ethnic women in North East of Iran. World J Med Sci 2012;7:17-22.  Back to cited text no. 6
    
7.
Shahini N, Shahini I, Marjani A. Prevalence of metabolic syndrome in Turkmen ethnic groups in Gorgan. J Clin Diagn Res 2013;7: 1849-51.  Back to cited text no. 7
    
8.
Marjani A, Shahini N, Agh-Atabay O, Tabari RG. Prevalence of metabolic syndrome among sistanee ethnic women. Adv Stud Biol 2012;4:363-72.  Back to cited text no. 8
    
9.
Marjani A, Shahini N. Age related metabolic syndrome among Fars ethnic women in Gorgan, Iran. J Pharm Biomed Sci 2013;30:929-35.  Back to cited text no. 9
    
10.
Marjani A, Moghasemi S. The Metabolic syndrome among postmenopausal Women in Gorgan. Int J Endocrinol 2012;2012: 953627.  Back to cited text no. 10
    
11.
Takeuchi H, Saitoh S, Takagi S, Ohnishi H, Ohhata J, Isobe T, et al. Metabolic syndrome and cardiac disease in Japanese men: Applicability of the concept of metabolic syndrome defined by the National Cholesterol Education Program-Adult Treatment Panel III to Japanese men - the Tanno and Sobetsu Study. Hypertens Res 2005;28:203-8.  Back to cited text no. 11
    
12.
Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288:2709-16.  Back to cited text no. 12
    
13.
Bobes J, Arango C, Aranda P, Carmena R, Garcia-Garcia M, Rejas J, et al. Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: Results of the CLAMORS Study. Schizophr Res 2007;90:162-73.  Back to cited text no. 13
    
14.
Hägg S, Lindblom Y, Mjörndal T, Adolfsson R. High prevalence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia. Int Clin Psychopharmacol 2006;21:93-8.  Back to cited text no. 14
    
15.
De Hert MA, van Winkel R, Van Eyck D, Hanssens L, Wampers M, Scheen A, et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res 2006;83:87-93.  Back to cited text no. 15
    
16.
Heiskanen T, Niskanen L, Lyytikäinen R, Saarinen PI, Hintikka J. Metabolic syndrome in patients with schizophrenia. J Clin Psychiatry 2003;64:575-9.  Back to cited text no. 16
    
17.
McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res 2005;80:19-32.  Back to cited text no. 17
    
18.
Cohn T, Prud›homme D, Streiner D, Kameh H, Remington G. Characterizing coronary heart disease risk in chronic schizophrenia: High prevalence of the metabolic syndrome. Can J Psychiatry 2004; 49:753-60.  Back to cited text no. 18
    
19.
Newcomer JW. Metabolic syndrome and mental illness. Am J Manag Care 2007;13 7 Suppl:S170-7.  Back to cited text no. 19
    
20.
Takeshita J, Masaki K, Ahmed I, Foley DJ, Li YQ, Chen R, et al. Are depressive symptoms a risk factor for mortality in elderly Japanese American men? the Honolulu-Asia Aging Study. Am J Psychiatry 2002;159:1127-32.  Back to cited text no. 20
    
21.
Goodwin RD, Davidson JR. Self-reported diabetes and posttraumatic stress disorder among adults in the community. Prev Med 2005;40: 570-4.  Back to cited text no. 21
    
22.
Weber-Hamann B, Hentschel F, Kniest A, Deuschle M, Colla M, Lederbogen F, et al. Hypercortisolemic depression is associated with increased intra-abdominal fat. Psychosom Med 2002;64:274-7.  Back to cited text no. 22
    
23.
Schweiger U, Weber B, Deuschle M, Heuser I. Lumbar bone mineral density in patients with major depression: Evidence of increased bone loss at follow-up. Am J Psychiatry 2000;157:118-20.  Back to cited text no. 23
    
24.
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;39:306-18.  Back to cited text no. 24
    
25.
Maaroganye K, Mohapi M, Krüger C, Rheeder P. The prevalence of metabolic syndrome and its associated factors in long-term patients in a specialist psychiatric hospital in South Africa. Afr J Psychiatry 2013;16:16:414-23.  Back to cited text no. 25
    
26.
Parabiaghi A, Bonetto C, Ruggeri M, Lasalvia A, Leese M. Severe and persistent mental illness: A useful definition for prioritizing community-based mental health service interventions. Soc Psychiatry Psychiatr Epidemiol 2006;41:457-63.  Back to cited text no. 26
    
27.
De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011;10:52-77.  Back to cited text no. 27
    
28.
De Hert M, Dekker JM, Wood D, Kahl KG, Holt RI, Möller HJ. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 2009;24:412-24.  Back to cited text no. 28
    
29.
Hanley AJ, Karter AJ, Williams K, Festa A, D′Agostino RB Jr, Wagenknecht LE, et al. Prediction of type 2 diabetes mellitus with alternative definitions of the metabolic syndrome: The Insulin Resistance Atherosclerosis Study. Circulation 2005;112:3713-21.  Back to cited text no. 29
    
30.
Altekin E, Coker C, Sisman AR, Onvural B, Kuralay F, Kirimli O. The relationship between trace elements and cardiac markers in acute coronary syndromes. J Trace Elem Med Biol 2005;18:235-42.  Back to cited text no. 30
    
31.
World Health Organization. Prevention and Management of the Global Epidemic of Obesity. Report of the WHO Consultation on Obesity. (Technical Report Series, No. 894). Geneva: WHO; 1998.  Back to cited text no. 31
    
32.
Kato M, Gonzalez-Blanco M, Sotelo J. Metabolic syndrome in schizophrenia: A pilot study. Presented at the 156 th Annual Meeting of the American Psychiatric Association, San Francisco, Calif.; 17-22, May 2003.  Back to cited text no. 32
    
33.
Bressington DT, Mui J, Cheung EF, Petch J, Clark AB, Gray R. The prevalence of metabolic syndrome amongst patients with severe mental illness in the community in Hong Kong - a cross sectional study. BMC Psychiatry 2013;13:87.  Back to cited text no. 33
    
34.
Straker DA, Rubens E, Koshy F, Kramer E, Manu P. The prevalence of the metabolic syndrome among patients treated with atypical antipsychotic. San Francisco: Abstract Presented at the American Psychiatric Association Annual Meeting; 2003.  Back to cited text no. 34
    
35.
Kato MM, Currier MB, Gomez CM, Hall L, Gonzalez-Blanco M. Prevalence of Metabolic syndrome in Hispanic and non-Hispanic patients with schizophrenia. Prim Care Companion J Clin Psychiatry 2004;6:74-77.  Back to cited text no. 35
    
36.
John AP, Koloth R, Dragovic M, Lim SC. Prevalence of metabolic syndrome among Australians with severe mental illness. Med J Aust 2009;190:176-9.  Back to cited text no. 36
    
37.
Littrell KH, Petty R, Ortega TR, Moore D, Ballard A, Clough R, et al. Insulin resistance and syndrome X among patients with schizophrenia. San Francisco: Abstract Presented at the American Psychiatric Association Annual Meeting; 2003.  Back to cited text no. 37
    
38.
Srisurapanont M, Likhitsathian S, Boonyanaruthee V, Charnsilp C, Jarusuraisin N. Metabolic syndrome in Thai schizophrenic patients: A naturalistic one-year follow-up study. BMC Psychiatry 2007;7:14.  Back to cited text no. 38
    
39.
Robson D, Gray R. Serious mental illness and physical health problems: A discussion paper. Int J Nurs Stud 2007;44:457-66.  Back to cited text no. 39
    
40.
Keenan TE, Yu A, Cooper LA, Appel LJ, Guallar E, Gennusa JV 3 rd , et al. Racial patterns of cardiovascular disease risk factors in serious mental illness and the overall U.S. population. Schizophr Res 2013;150:211-6.  Back to cited text no. 40
    
41.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-128.  Back to cited text no. 41
    
42.
Tirupati S, Chua LE. Obesity and metabolic syndrome in a psychiatric rehabilitation service. Aust N Z J Psychiatry 2007;41:606-10.  Back to cited text no. 42
    
43.
Lawrence D, Holman CD, Jablensky AV. Preventable physical illness in people with mental illness. Perth: University of Western Australia; 2001.  Back to cited text no. 43
    
44.
Taylor V, MacQueen G. Associations between bipolar disorder and metabolic syndrome: A review. J Clin Psychiatry 2006;67:1034-41.  Back to cited text no. 44
    
45.
Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry 1998;173:11-53.  Back to cited text no. 45
    
46.
Suvisaari JM, Saarni SI, Perälä J, Suvisaari JV, Härkänen T, Lönnqvist J, et al. Metabolic syndrome among persons with schizophrenia and other psychotic disorders in a general population survey. J Clin Psychiatry 2007;68:1045-55.  Back to cited text no. 46
    
47.
Fagiolini A, Frank E, Scott JA, Turkin S, Kupfer DJ. Metabolic syndrome in bipolar disorder: Findings from the Bipolar Disorder Center for Pennsylvanians. Bipolar Disord 2005;7:424-30.  Back to cited text no. 47
    
48.
Heiskanen TH, Niskanen LK, Hintikka JJ, Koivumaa-Honkanen HT, Honkalampi KM, Haatainen KM, et al. Metabolic syndrome and depression: A cross-sectional analysis. J Clin Psychiatry 2006;67: 1422-7.  Back to cited text no. 48
    
49.
Lambert TJ, Chapman LH, Consensus Working Group. Diabetes, psychotic disorders and antipsychotic therapy: A consensus statement. Med J Aust 2004;181:544-8.  Back to cited text no. 49
    
50.
Zimmet PZ, Alberti KG, Shaw JE. Mainstreaming the metabolic syndrome: A definitive definition. Med J Aust 2005;183:175-6.  Back to cited text no. 50
    
51.
Janus ED, Laatikainen T, Dunbar JA, Kilkkinen A, Bunker SJ, Philpot B, et al. Overweight, obesity and metabolic syndrome in rural south eastern Australia. Med J Aust 2007;187:147-52.  Back to cited text no. 51
    
52.
Holt RI, Peveler RC, Byrne CD. Schizophrenia, the metabolic syndrome and diabetes. Diabet Med 2004;21:515-23.  Back to cited text no. 52
    
53.
Alberti 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.  Back to cited text no. 53
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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