Psychosomatics
Journal Home Search Current Issue Past Issues Subscribe All APPI Journals Help Contact Us
 
Psychosomatics 47:491-497, December 2006
doi: 10.1176/appi.psy.47.6.491
© 2006 Academy of Psychosomatic Medicine
Quicksearch
Advanced Search
Or Search All APPI Journals
This Article
* Abstract Freely available
* Full Text (PDF)
* Alert me when this article is cited
* Alert me if a correction is posted
* Citation Map
Services
* Email this article to a Colleague
* Similar articles in this journal
* Similar articles in PubMed
* Alert me to new issues of the journal
* Add to My Articles & Searches
* Download to citation manager
* reprints & permissions
Citing Articles
* Citing Articles via Google Scholar
Google Scholar
* Articles by Bermudes, R. A.
* Articles by Welge, J. A.
* Search for Related Content
PubMed
* PubMed Citation
* Articles by Bermudes, R. A.
* Articles by Welge, J. A.
Related Collections
* Syndromes Secondary to General Medical Disorders

The Prevalence of the Metabolic Syndrome in Psychiatric Inpatients With Primary Psychotic and Mood Disorders

Richard A. Bermudes, M.D., Paul E. Keck, Jr., M.D., and Jeffrey A. Welge, Ph.D.

Received November 30, 2004; revised October 25, 2005; accepted November 29, 2005. From the Dept. of Psychiatry and Behavioral Sciences, UC Davis Medical Center, Sacramento, CA (RAB); the Psychopharmacology Research Program, Dept. of Psychiatry, Univ. of Cincinnati College of Medicine; General Clinical Research Center and Mental Health Care Line, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio (PEK), and the Quantitative Methods Program, Dept. of Psychiatry, Univ. of Cincinnati College of Medicine, Division of Epidemiology and Biostatistics, Dept. of Environmental Health, Univ. of Cincinnati College of Medicine (JAW). Send correspondence and reprint requests to Richard A. Bermudes, M.D., Dept. of Psychiatry and Behavioral Sciences, UC Davis Medical Center, 2230 Stockton Blvd., Sacramento, CA 95817-1419. e-mail: rabermudes{at}ucdavis.edu


  ABSTRACT

 
TOP
 ABSTRACT
INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
Patients with severe mental illness have elevated rates of cardiovascular disease (CVD) and diabetes compared with the general population, but little is known about the prevalence of the metabolic syndrome that predisposes patients with severe mental illness to both medical conditions. The purpose of this study was to assess the prevalence of the metabolic syndrome by surveying hospital records of psychiatric inpatients with severe mood and psychotic disorders. The study group was 102 consecutively admitted adult patients with a primary DSM-IV diagnosis of a mood or psychotic disorder. Criteria for comorbid metabolic syndrome required at least three of the five factors defined by the National Cholesterol Education Program. The prevalence of the metabolic syndrome was 38.6% in this cohort, and it was associated with increasing age, body mass index, and Caucasian ethnicity. The metabolic syndrome was common in this cohort of psychiatric inpatients, and the high rate of the metabolic syndrome likely represents an intermediate step in the future development of CVD and diabetes, which may provide a point of early intervention to prevent the occurrence of these two medical illnesses in chronically mentally ill patients.


  INTRODUCTION

 
TOP
 ABSTRACT
 INTRODUCTION
METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
Mental and medical illnesses frequently co-occur. In a series of 78 psychiatric inpatients with chronic mental illness, Knutson found that 72% had unrecognized medical conditions.1 Medical illness complicates the treatment of mental illness, and patients with severe mental illness die at an earlier age from physical health problems than do those without mental illness.2,3 High rates of diabetes and cardiovascular disease (CVD) contribute to this premature mortality in severely mentally ill patients.4 However, the mechanisms leading to elevated rates of diabetes and CVD in this population remain uncertain.

In the general adult population, the metabolic syndrome is an intermediate step toward the final endpoint of Type II diabetes and CVD.5,6 Fundamental to this syndrome is the accumulation of visceral fat. Visceral fat itself is more insulin-resistant than lower-body adipose tissue. Also, visceral fat causes increased free fatty acids in the systemic circulation, which, in turn elicits decreased glucose tolerance, elevated blood pressure, and dyslipidemia.

In 2001, the Third Report of the National Cholesterol Education Program Adult Treatment Panel (ATP III) included diagnostic guidelines for the metabolic syndrome and proposed that it be a secondary target of intervention after reducing low-density lipoprotein (LDL) in at-risk patients. The ATP III criteria require the presence of more than three of the following for the diagnosis of the metabolic syndrome: 1) abdominal obesity; 2) elevated triglyceride level; 3) low high-density lipoprotein level (HDL); 4) high blood pressure; and 5) an elevated fasting glucose level.7

Individuals with the metabolic syndrome have higher rates of coronary heart disease, myocardial infarction, and stroke than individuals with any one of the components of hypertension, insulin-resistance, dyslipidemia, or obesity.8 Lakka et al.9 found that men with the metabolic syndrome were 2–4 times more likely to die from coronary heart disease and twice as likely to die of any cause than those without the metabolic syndrome, even after adjustment for conventional cardiovascular risk factors.

The prevalence of the metabolic syndrome varies depending on the average body mass index (BMI), age, and ethnicity of the population.10 In 2002, using data collected during the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994), Ford et al.11 calculated an overall prevalence of the syndrome of 21.8% in the adults in the United States. The prevalence of the syndrome increased with BMI to a rate of 59.6% in obese men (BMI >30), and was highest in Mexican Americans and lowest in African Americans.

Two studies examined the prevalence of the metabolic syndrome in persons with mental illness.12,13 In 35 Finnish outpatients with schizophrenia, Heiskanen et al.12 found an overall prevalence rate of 37%. In a large, cross-sectional study utilizing NHANES III data, younger women with a history of depression were twice as likely to have the metabolic syndrome as were women without a history of major depression.13

In this study, we retrospectively assessed the rate of the metabolic syndrome in a cohort of psychiatric inpatients with severe and recurrent mood and psychotic disorders. Second, we assessed whether the prevalence of the syndrome was associated with demographic, lifestyle, psychiatric illness characteristics, or treatment factors that were reversible or nonreversible.


  METHOD

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
RESULTS
 DISCUSSION
 REFERENCES
 
We retrospectively collected data from consecutive adult psychiatric inpatients admitted to the University of Cincinnati Medical Center with a primary DSM-IV14 diagnosis of schizophrenia, schizoaffective disorder, psychosis not otherwise specified, bipolar disorders, and major depressive disorders from November 1, 2003 to March 30, 2004. We included patients at least 18 years old, under the care of a single attending physician (RAB), with data present in the medical record regarding at least three of the five parameters of the metabolic syndrome, to generate a group of 102 subjects. We excluded patients with incomplete data (i.e., patients with only two data-points); pregnant patients; patients with primary anxiety disorders, substance abuse, or Axis II disorders; and patients whose primary attending physician was not RAB. The University of Cincinnati institutional review board (IRB) chair approved a waiver for this study.

Weight, height, clinical laboratory results, and blood pressure were obtained from the medical record. For weight and height measurements, a standiometer (calibrated metal ruler attached to the balance scale that measures height) and basic physician’s adult balance-beam scale are used by nurses during the admission process. Waist circumference is obtained by measuring the patient’s maximal girth between the umbilicus and the top of the iliac crest.

For the purposes of the study, we defined blood pressure (BP) as the average of the BP recorded during the patient’s hospital stay. We verified, by reviewing physician order forms, that fasting triglyceride, HDL cholesterol, and glucose level were obtained at ≥ 6 hours of fasting. With a physician’s order for fasting labs, nurses and staff instruct patients not to eat after midnight; this is verified and documented by the phlebotomist at the time of the blood draw, and the patient’s breakfast tray is held until after 7 A.M. on the following day.

Subjects met criteria for the metabolic syndrome if three of the following ATP III-defined criteria were present: 1) waist circumference > 102 cm (40 inches) in men or > 88 cm (35 inches) in women; 2) elevated serum triglycerides ≥ 150 mg/dL (≥ 1.69 mmol/L); 3) low serum HDL cholesterol (< 40 mg/dL [ < 1.03 mmol/L]) in men or < 50 mg/dL (< 1.29 mmol/dL) in women; 4) high systolic blood pressure (≥ 130 mm Hg) or high diastolic blood pressure (≥ 85 mm Hg; 5) high fasting plasma glucose level (≥ 110 mg/dL).7 Also, individuals met the criteria for high blood pressure or elevated glucose level if they were taking medicines for diabetes or hypertension.

We assessed each subject’s demographic profile, psychiatric, medical, and medication history by reviewing the subject’s hospital record. We categorized income, education, and smoking status as follows: 1) annual income: <$15,000; $15,000–$25,000; >$25,000; and Unknown; 2) education level: <8 years; 8–12 years; >12 years; and Unknown; 3) smoking status: current; past (if smoked ≥100 cigarettes ever); Never.

Patients were considered to be physically active if they regularly engaged in an aerobic type of activity at least twice per week for 20 minutes; these included walking, jogging, swimming, or garden/yard work.10 We categorized patients as having a family history of diabetes or CVD if the patient had a first-degree relative with either of these two illnesses.

Medication history was based on information documented in the medical record and included reports from the patient, outpatient providers, or previous hospitalizations. We further reviewed the subjects’ hospital record for menopausal status, history of gestational diabetes or having a child weighing ≥9 lbs, primary Axis I diagnosis, evidence of substance abuse, number of previous hospitalizations, age at onset of illness, current Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scores, and medical history. We defined subjects as having substance abuse if they had a positive drug screen upon admission or if there was documentation in the history that they had ongoing substance abuse or dependence, despite a negative drug screen.

We performed statistical analysis with the SAS for the personal computer, Version 8.1 (SAS institute; Cary, NC). Categorical variables were compared by using a two-tailed Fisher exact test. Continuous variables were compared by Welch-Satterthwaite t-test for unequal variances. Results were considered significant when p was ≤0.05.


  RESULTS

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
DISCUSSION
 REFERENCES
 
The anthropometric characteristics of the study sample are summarized in Table 1. Subjects with the metabolic syndrome were older (p <0.001), had larger waist circumferences (p=0.03), and BMIs (p <0.001).


View this table:
[in this window]
[in a new window]

 

TABLE 1. Anthropometric Characteristics of the Study Sample



The overall prevalence of the metabolic syndrome in this group of psychiatric inpatients was 38.6% (N=39). For subjects ages 18–29, the BMI-adjusted prevalence rate was 15.5% (Figure 1). Subjects ages 30–39 and 40–49 had an adjusted rate of 39.6%, whereas subjects older than age 50 had a prevalence rate of 69.9% (Figure 1. The prevalence of the metabolic syndrome increased with increasing BMI (Figure 2). After adjustment for age, normal-weight subjects (BMI ≤25) had a rate of 4%; overweight subjects (BMI >25 but ≤30) had a rate of 39%; and obese subjects (BMI >30) had a rate of 58%.


Figure 1
View larger version (32K):
[in this window]
[in a new window]

 

FIGURE 1.  Prevalence of the Metabolic Syndrome by Age

Prevalence rates were adjusted for Body Mass Index (BMI; estimated prevalence for BMI: 30).



Figure 2
View larger version (34K):
[in this window]
[in a new window]

 

FIGURE 2.  Prevalence of the Metabolic Syndrome by Body Mass Index (BMI)

Prevalence rates were adjusted for age (estimated prevalence at age 38).

a BMI≤25.

b 25<BMI≤30.

c BMI>30.


Table 2 displays the univariate analysis of the sociodemographic characteristics of the study sample and their association with the prevalence of the metabolic syndrome. Compared with African Americans, Caucasians were more likely to meet criteria for the metabolic syndrome (52.9% versus 24.5%; p=0.004). The metabolic syndrome was not associated with gender, income, education, smoking history, physical activity, menopausal status, history of gestational diabetes, family history of cardiovascular disease, or family history of diabetes.


View this table:
[in this window]
[in a new window]

 

TABLE 2. Sociodemographic Characteristics of the Study Sample



Multiple logistic regression, using the variables race, gender, income, education, tobacco use, physical activity, family history of diabetes, and family history of CVD showed similar results. Compared with univariate analysis (Table 2), income was slightly more significantly associated with the metabolic syndrome (p=0.02) and race, slightly less (p=0.014).

Severity of illness characteristics and the prevalence of the metabolic syndrome are shown in Table 3. Later onset of illness was associated with the metabolic syndrome (p=0.002), and there was a trend toward an association with duration of illness (p=0.061). Current GAF, CGI, or number of hospitalizations were not associated with the metabolic syndrome. Also, individual disorders, diagnostic groups, and individual medications, as well as medication classes, were not found to be associated with the metabolic syndrome in this sample.


View this table:
[in this window]
[in a new window]

 

TABLE 3. Severity of Illness and Distribution of the Metabolic Syndrome



Each component of the metabolic syndrome was significantly associated with the full syndrome. Compared with those having a normal waist circumference, subjects with a larger waist had a higher rate of the metabolic syndrome (8.6% versus 56.3%; p <0.001). Subjects with elevated triglyceride levels had a higher prevalence rate (81.3%) than those with normal triglycerides (17.5%; p <0.001). Lower HDL was associated with the syndrome (65.1% versus 17.3%; p <0.001), as was high BP (70.7% versus 14.6%; p <0.001) and elevated fasting glucose (73.9% versus 28.4%; p <0.001).


  DISCUSSION

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
REFERENCES
 
In this sample of severely mentally ill patients, 38.6% met criteria for the metabolic syndrome as defined by ATP III guidelines. This rate is elevated, compared with the rate of 21.4% found by Ford and others in the United States general population during the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994).11 Similar to NHANES III data, increasing age, BMI, and Caucasian ethnicity increased the risk for the metabolic syndrome. Persons with higher incomes were at increased risk for the metabolic syndrome, which suggests that those of higher socioeconomic status may be at increased risk.

Our study adds to the mounting evidence that mentally ill patients are at increased risk for the metabolic syndrome. In a group of 35 Finnish outpatients with schizophrenia, 37% met criteria for the metabolic syndrome.12 Depression and depressive symptoms are also associated with the metabolic syndrome. In a re-examination of the NHANES III data, young adult women (ages 17–39) with a history of depression had an increased risk for the metabolic syndrome, as compared with women with no history of depression.13 Furthermore, McCaffery et al.15 found an association with depressive symptoms and the metabolic syndrome in monozygotic and dizygotic male twin pairs who participated in the National Heart, Lung, and Blood Institute Twin Study.

There are several reasons why severe mood and psychotic disorders might be associated with higher rates of the metabolic syndrome. Certain lifestyles, such as sedentary habits and high fat and carbohydrate diets, are common in people with severe mental illness and are associated with the metabolic syndrome.16,17

Second, atypical antipsychotics are associated with obesity, dyslipidemia, and hyperglycemia, three features of the metabolic syndrome. For example, moderate-to-severe elevations in triglycerides, weight, and leptin have been closely associated with clozapine, olanzapine, risperidone, and quetiapine therapy, and there are case reports linking clozapine, olanzapine, quetiapine, and risperidone to hyperglycemia.18,19

Finally, severe mood disorders and psychotic disorders may predispose individuals to physiological changes that increase the rate of the metabolic syndrome. Abnormalities of glucose regulation, with a pattern of insulin resistance, have been described in schizophrenic patients even before the development of illness and the use of antipsychotic agents.20,21 In two recent studies, Thakore et al. found increased central obesity in untreated first-episode patients diagnosed with schizophrenia or major depression.22,23 Both depression and schizophrenia have been associated with dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, which has been implicated in the development of the metabolic syndrome.24–28

There are limitations to our findings: Foremost was the cross-sectional nature of the study. Although the metabolic syndrome was frequent in this group of inpatients, causal pathways could not be inferred.

Second, the small sample size and the limited medication history available limited the power of this investigation to detect significant differences among potentially important subgroups. For example, it was impossible to determine whether any particular medications were associated with the metabolic syndrome or any specific rate differences were present between the different diagnoses. This may also explain why we did not find an association between the metabolic syndrome and family history of diabetes. Also, our data were from a retrospective chart review and were limited by the history-taking of the original clinicians and reporting by the patients.

Third, not all of the five features of the metabolic syndrome were measured in each subject: 14 subjects were missing at least one component, and 5 subjects were missing two components. Thus, our measured prevalence rate was likely an underestimate of the prevalence of the metabolic syndrome in this sample.

Finally, there was no reference population without psychopathology. Although there are national rates available from the NHANES III, this survey was from 1988 to 1994. If rates for the metabolic syndrome parallel the increasing national rates for diabetes, these data from the NHANES likely underrepresent the present-day frequency of the metabolic syndrome.

Despite these limitations, our findings are consistent with high rates of the metabolic syndrome found in other psychiatric patient populations. Our study indicated that more than 1 in 3 chronically mentally ill patients had the metabolic syndrome and therefore harbored what is usually a clinically silent and unidentified elevated risk for cardiovascular disease and Type II diabetes. Furthermore, when one component of the syndrome was present, the rate increased to 1 in 2 patients meeting criteria for the full syndrome.

Psychiatrists should consider measuring BP and waist circumference, two components of the metabolic syndrome, which are easily assessed in the office setting. In this sample, subjects who had an elevated BP and large waist circumference met criteria for the full syndrome 86% of the time (25 of 29 subjects; see Table 4). Screening for the metabolic syndrome by use of BP and waist measurement was 71% sensitive and 93% specific. Abnormalities in either BP or waist circumference warrant screening for the other components of the syndrome, more frequent monitoring of fasting glucose and lipids, and further interventions such as diet- and exercise-counseling to reverse the changes.


View this table:
[in this window]
[in a new window]

 

TABLE 4. Blood Pressure and Waist Circumference as a Screen for the Metabolic Syndrome



All patients taking atypical antipsychotics require monitoring of weight, fasting glucose, and lipids.29–32 Failure to monitor metabolic parameters and intervene early may result in continued high rates of morbidity in severely mentally ill patients secondary to complications of CVD and diabetes. Because the root causes of the metabolic syndrome for a majority of individuals with chronic mental illness may be poor diet, insufficient physical activity, and side effects from medications, the high prevalence of the syndrome underscores an urgent need to develop comprehensive efforts directed at controlling the obesity epidemic and improving physical activity levels within the population of chronic mentally ill patients.33


  REFERENCES

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Knutsen E, DuRand C: Previously unrecognized physical illness in psychiatric patients. Hosp Community Psychiatry 1991; 42:182–186[Abstract/Free Full Text]
  2. Lyketsos CG, Dunn G, Kaminsky MJ, et al: Medical comorbidity in psychiatric inpatients: relation to clinical outcomes and hospital length of stay. Psychosomatics 2002; 43:24–30[Abstract/Free Full Text]
  3. Brown S, Inskip H, Barraclough B: Causes of the excess mortality of schizophrenia. Br J Psychiatry 2000; 177:212–217[Abstract/Free Full Text]
  4. Osby U, Correia N, Brandt L, et al: Mortality and causes of death in schizophrenia in Stockholm County, Sweden. Schizophr Res 2000; 45:21–28[CrossRef][Medline]
  5. Lemipianinen P, Mykkanen L, Pyorala K, et al: Insulin-resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation 1999; 100:123–128[Abstract/Free Full Text]
  6. Kekalainen P, Sarlund H, Pyorala K, et al: Hyperinsulinemia cluster predicts the development of Type 2 diabetes independent of a family history of diabetes. Diabetes Care 1999; 22:86–92[Abstract/Free Full Text]
  7. National Institutes of Health: Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, MD, National Institutes of Health, 2001. NIH Publication 01-3670
  8. Isomaa B, Amgren P, Tuomi T, et al: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24:683–689[Abstract/Free Full Text]
  9. Lakka HM, Laaksonen DE, Lakka TA, et al: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288:2709–2716[Abstract/Free Full Text]
  10. Park YW, Zhu S, Palaniappan L, et al: Prevalence and associated risk factor findings in the U.S. population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003; 163:427–436[Abstract/Free Full Text]
  11. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among U.S. adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 2002; 287:356–359[Abstract/Free Full Text]
  12. Heiskanen T, Niskanen L, Lyytikainen R, et al: Metabolic syndrome in patients with schizophrenia. J Clin Psychiatry 2003; 64:575–579[Medline]
  13. Kinder LS, Carnethon MR, Palaniappan LP, et al: Depression and the metabolic syndrome in young adults: findings from the Third National Health and Nutrition Examination Survey. Psychosom Med 2004; 66:316–322[Abstract/Free Full Text]
  14. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994
  15. McCaffery JM, Niaura R, Todaro JF, et al: Depressive symptoms and metabolic risk in adult male twins enrolled in the National Heart, Lung, and Blood Institute Twin Study. Psychosom Med 2003; 65:490–497[Abstract/Free Full Text]
  16. Davidson S, Judd F, Jolley D, et al: Cardiovascular risk factors for people with mental illness. Aust N Z J Psychiatry 2001; 35:196–202[CrossRef][Medline]
  17. Brown S, Birtwistle J, Roe L, et al: The unhealthy lifestyle of people with schizophrenia. Psychol Med 1999; 29:697–701[CrossRef][Medline]
  18. Atmaca M, Kuloglu M, Tezcan E, et al: Serum leptin and triglyceride levels in patients on treatment with atypical antipsychotics. J Clin Psychiatry 2003; 64:598–604[Medline]
  19. Haupt DW, Newcomer JW: Hyperglycemia and antipsychotic medications. J Clin Psychiatry 2001; 62(suppl27):15-26
  20. Kasanin J: The blood sugar curve in mental disease. Arch Neurol Psychiatry 1926; 16:414–419
  21. Meduna LJ, Gerty FJ, Urse VG: Biochemical disturbances in mental disorders. Arch Neurol Psychiatry 1942; 47:38–52
  22. Ryan MCM, Flanagan S, Kinsella U, et al: The effects of atypical antipsychotics on visceral fat distribution in first episode, drug-naïve patients with schizophrenia. Life Sci 2004; 74:1999–2008[CrossRef][Medline]
  23. Thakore JH, Richards PJ, Rezneck RH, et al: Increased intra-abdominal fat deposition in patients with major depressive illness as measured by computed tomography. Biol Psychiatry 1997; 41:1140–1142[CrossRef][Medline]
  24. Siever LJ, Davis KL: Overview: toward a dysregulation hypothesis of depression. Am J Psychiatry 1985; 142:1017–1031[Abstract/Free Full Text]
  25. Kocsis JH, Davis JM, Katz MM, et al: Depressive behavior and hyperactive adrenocortical function. Am J Psychiatry 1985; 142:1291–1298[Abstract/Free Full Text]
  26. Jansen L, Gispen-de Wied CC, Gademan PJ, et al: Blunted cortisol response to a psychosocial stressor in schizophrenia. Schizophr Res 1998; 33:87–94[Medline]
  27. Kudoh KA, Kudo T, Matsuki A: Depressed pituitary-adrenal response to surgical stress in chronic schizophrenic patients. Neuropsychobiology 1997; 36:112–116[Medline]
  28. Brunner EJ, Hemingway H, Walker BR, et al: Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome. Circulation 2002; 106:2659–2665[Abstract/Free Full Text]
  29. Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes Care 2004; 27:596–601[Free Full Text]
  30. Casey DE, Haupt DW, Newcomer JW, et al: Antipsychotic-induced weight gain and metabolic abnormalities: implications for increased mortality in patients with schizophrenia. J Clin Psychiatry 2004; 65(suppl7):4-18
  31. Marder SR, Essock SM, Miller AL, et al: Physical health monitoring of patients with schizophrenia. Am J Psychiatry 2004; 161:1334–1349[Abstract/Free Full Text]
  32. Keck PE Jr, Buse JB, Dagogo-Jack S, et al: Managing metabolic concerns in patients with severe mental illness: a special report. Postgrad Med, McGraw-Hill, Minneapolis, MN, 2003; pp 1-92
  33. Prevalence Among U.S. Adults of a Metabolic Syndrome Associated with Obesity: Findings from the Third NHANES Survey. Centers for Disease Control and Prevention. available at http://www.cdc.gov/nccdphp/dnpa/obesity/trend/metabolic.htm




This Article
* Abstract Freely available
* Full Text (PDF)
* Alert me when this article is cited
* Alert me if a correction is posted
* Citation Map
Services
* Email this article to a Colleague
* Similar articles in this journal
* Similar articles in PubMed
* Alert me to new issues of the journal
* Add to My Articles & Searches
* Download to citation manager
* reprints & permissions
Citing Articles
* Citing Articles via Google Scholar
Google Scholar
* Articles by Bermudes, R. A.
* Articles by Welge, J. A.
* Search for Related Content
PubMed
* PubMed Citation
* Articles by Bermudes, R. A.
* Articles by Welge, J. A.
Related Collections
* Syndromes Secondary to General Medical Disorders

Get information about faster international access.

Privacy Policy

Copyright © 2006 Academy of Psychosomatic Medicine. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us

American Psychiatric Publishing, Inc. Academy of Psychosomatic Medicine
1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901 * 800-368-5777 * appi at psych.org