Tara Haelle

Three short screening questionnaires that do not require specialized training to administer have been shown to be comparable in identifying female adolescents at risk of developing psychosis, according to a study published in Schizophrenia Research.

The Yale PRIME Screen–Revised, the Youth Psychosis at-Risk Questionnaire–Brief (YPARQ-B), and the Prodromal Questionnaire–Brief (PQ-B) each adequately provided a useful assessment for Attenuated Psychosis Syndrome (APS), when compared with the Structured Interview for Prodromal Risk Syndromes (SIPS).

Although past research has shown that the short screening tools were comparable to one another, "no study to date has examined the relations between several simultaneously administered screening measures and interview-based APS status in an effort to determine which measure relates most strongly to a ‘gold-standard,’ " reported Emily Kline and her associates at the University of Maryland in Baltimore (Schizophr. Res. 2012:141;72-7 [doi:10.1016/j.schres.2012.07.022]).

Having brief questionnaires to reliably screen for APS offers broader and more affordable screening options since SIPS requires more time and a trained practitioner to administer.

The researchers recruited 49 study participants (76% of whom were female) aged 12-22 years from community clinics and a psychiatric inpatient treatment unit and through advertisements. All participants were currently receiving mental health services and had a mean age of 16.72 years. The ethnically diverse group included black (43%), white (39%), Asian (2%), Native American (2%), and multiracial (12%) patients. A total of 2% did not report race, and 8% identified as Hispanic, reported Ms. Kline and her associates.

The participants filled out each of the three short screens before being interviewed by a trained health professional using SIPS. The screens were provided to participants in alternating order (Latin square design) to reduce the likelihood of bias from the order in which the screens were completed.

The results of the screenings were then analyzed against the diagnoses found from the SIPS to determine concurrence, with normality, outliers, and possible ordering effects taken into account. SIPS can lead to four diagnoses (present psychosis, psychosis risk syndromes, schizotypal personality disorder, and no evidence of psychosis/risk) and has previously accurately predicted psychoses within 2.5 years for 35% of those meeting psychosis risk syndrome criteria.

The authors reported that all three short screens provided valuable, reliable results related to psychosis risk. "Through analyses intended to parse the relative merits of the three measures, no single tool emerged as a clear front-runner," the authors reported. "The choice of which among the three instruments to use will likely depend on the assessors’ goals."

They noted that PRIME Screen was the easiest and quickest to administer and score, but the longer time required for the YPARQ-B paid off with the highest level of accuracy. PRIME Screen had 61% accuracy while YPARQ-B’s accuracy was 71% and PQ-B’s was 55%.

The authors noted that the findings may not be generalizable since the participants were young and predominantly female. The small sample size also may have led to underpowered test results; more than 200 participants would be required to detect clinically significant differences between the correlations, they reported.

The study was funded partly by a Research Seed Funding Initiative grant from the University of Maryland, Baltimore County, and by the University of Maryland division of child and adolescent psychiatry. The authors reported no disclosures.

Three short screening questionnaires that do not require specialized training to administer have been shown to be comparable in identifying female adolescents at risk of developing psychosis, according to a study published in Schizophrenia Research.

The Yale PRIME Screen–Revised, the Youth Psychosis at-Risk Questionnaire–Brief (YPARQ-B), and the Prodromal Questionnaire–Brief (PQ-B) each adequately provided a useful assessment for Attenuated Psychosis Syndrome (APS), when compared with the Structured Interview for Prodromal Risk Syndromes (SIPS).

Although past research has shown that the short screening tools were comparable to one another, "no study to date has examined the relations between several simultaneously administered screening measures and interview-based APS status in an effort to determine which measure relates most strongly to a ‘gold-standard,’ " reported Emily Kline and her associates at the University of Maryland in Baltimore (Schizophr. Res. 2012:141;72-7 [doi:10.1016/j.schres.2012.07.022]).

Having brief questionnaires to reliably screen for APS offers broader and more affordable screening options since SIPS requires more time and a trained practitioner to administer.

The researchers recruited 49 study participants (76% of whom were female) aged 12-22 years from community clinics and a psychiatric inpatient treatment unit and through advertisements. All participants were currently receiving mental health services and had a mean age of 16.72 years. The ethnically diverse group included black (43%), white (39%), Asian (2%), Native American (2%), and multiracial (12%) patients. A total of 2% did not report race, and 8% identified as Hispanic, reported Ms. Kline and her associates.

The participants filled out each of the three short screens before being interviewed by a trained health professional using SIPS. The screens were provided to participants in alternating order (Latin square design) to reduce the likelihood of bias from the order in which the screens were completed.

The results of the screenings were then analyzed against the diagnoses found from the SIPS to determine concurrence, with normality, outliers, and possible ordering effects taken into account. SIPS can lead to four diagnoses (present psychosis, psychosis risk syndromes, schizotypal personality disorder, and no evidence of psychosis/risk) and has previously accurately predicted psychoses within 2.5 years for 35% of those meeting psychosis risk syndrome criteria.

The authors reported that all three short screens provided valuable, reliable results related to psychosis risk. "Through analyses intended to parse the relative merits of the three measures, no single tool emerged as a clear front-runner," the authors reported. "The choice of which among the three instruments to use will likely depend on the assessors’ goals."

They noted that PRIME Screen was the easiest and quickest to administer and score, but the longer time required for the YPARQ-B paid off with the highest level of accuracy. PRIME Screen had 61% accuracy while YPARQ-B’s accuracy was 71% and PQ-B’s was 55%.

The authors noted that the findings may not be generalizable since the participants were young and predominantly female. The small sample size also may have led to underpowered test results; more than 200 participants would be required to detect clinically significant differences between the correlations, they reported.

The study was funded partly by a Research Seed Funding Initiative grant from the University of Maryland, Baltimore County, and by the University of Maryland division of child and adolescent psychiatry. The authors reported no disclosures.

Three short screening questionnaires that do not require specialized training to administer have been shown to be comparable in identifying female adolescents at risk of developing psychosis, according to a study published in Schizophrenia Research.

The Yale PRIME Screen–Revised, the Youth Psychosis at-Risk Questionnaire–Brief (YPARQ-B), and the Prodromal Questionnaire–Brief (PQ-B) each adequately provided a useful assessment for Attenuated Psychosis Syndrome (APS), when compared with the Structured Interview for Prodromal Risk Syndromes (SIPS).

Although past research has shown that the short screening tools were comparable to one another, "no study to date has examined the relations between several simultaneously administered screening measures and interview-based APS status in an effort to determine which measure relates most strongly to a ‘gold-standard,’ " reported Emily Kline and her associates at the University of Maryland in Baltimore (Schizophr. Res. 2012:141;72-7 [doi:10.1016/j.schres.2012.07.022]).

Having brief questionnaires to reliably screen for APS offers broader and more affordable screening options since SIPS requires more time and a trained practitioner to administer.

The researchers recruited 49 study participants (76% of whom were female) aged 12-22 years from community clinics and a psychiatric inpatient treatment unit and through advertisements. All participants were currently receiving mental health services and had a mean age of 16.72 years. The ethnically diverse group included black (43%), white (39%), Asian (2%), Native American (2%), and multiracial (12%) patients. A total of 2% did not report race, and 8% identified as Hispanic, reported Ms. Kline and her associates.

The participants filled out each of the three short screens before being interviewed by a trained health professional using SIPS. The screens were provided to participants in alternating order (Latin square design) to reduce the likelihood of bias from the order in which the screens were completed.

The results of the screenings were then analyzed against the diagnoses found from the SIPS to determine concurrence, with normality, outliers, and possible ordering effects taken into account. SIPS can lead to four diagnoses (present psychosis, psychosis risk syndromes, schizotypal personality disorder, and no evidence of psychosis/risk) and has previously accurately predicted psychoses within 2.5 years for 35% of those meeting psychosis risk syndrome criteria.

The authors reported that all three short screens provided valuable, reliable results related to psychosis risk. "Through analyses intended to parse the relative merits of the three measures, no single tool emerged as a clear front-runner," the authors reported. "The choice of which among the three instruments to use will likely depend on the assessors’ goals."

They noted that PRIME Screen was the easiest and quickest to administer and score, but the longer time required for the YPARQ-B paid off with the highest level of accuracy. PRIME Screen had 61% accuracy while YPARQ-B’s accuracy was 71% and PQ-B’s was 55%.

The authors noted that the findings may not be generalizable since the participants were young and predominantly female. The small sample size also may have led to underpowered test results; more than 200 participants would be required to detect clinically significant differences between the correlations, they reported.

The study was funded partly by a Research Seed Funding Initiative grant from the University of Maryland, Baltimore County, and by the University of Maryland division of child and adolescent psychiatry. The authors reported no disclosures.

Patients whose epilepsy was uncontrolled had more injuries, spent more time in the hospital, received more prescriptions, and incurred greater health care resource usage and costs than did patients whose epilepsy was under control in a retrospective, longitudinal matched-cohort study.

Additionally, uncontrolled epilepsy in private insurance patients incurred nearly $2,900 more in work time lost for disability and sick leave, comprising about one-fifth of these patients’ total direct health care costs.

Lead author Ranjani Manjunath of GlaxoSmithKline and her associates analyzed public and private insurance claims to determine how health care resource utilization and costs and epilepsy-related injuries differed between patients with uncontrolled epilepsy and those with well-controlled epilepsy. The findings were reported online Oct. 17 (Neurology 2012;79:1908-16).

The researchers defined patients with uncontrolled epilepsy as those who had at least two consecutive changes in their antiepileptic drug (AED) regimen (at least a month apart) and at least one subsequent hospitalization or emergency department visit within the next year. Patients taking AEDs but who had no changes in their therapy as well as no hospitalizations or ED visits were defined as having well-controlled epilepsy.

A total of 3,454 Medicaid patients and 602 private insurance patients with uncontrolled epilepsy were matched 1:1 with well-controlled epileptic patients for the study. Propensity score matching was used to reduce sample selection bias, and adjusted risk ratios for outcomes took into account age, sex, state or region, baseline AED use, use of other drugs known to increase seizure risk, baseline costs, and psychiatric conditions or epilepsy-related comorbidities (Alzheimer’s disease, brain tumor, meningitis, migraine, and stroke). A lower percentage of uncontrolled epilepsy patients were using AEDs at baseline: 48.1% of uncontrolled Medicaid patients, compared with 52.6% of well-controlled Medicaid patients (P less than .001), and 40% of uncontrolled private patients, compared with 45.5% of well-controlled private patients (P less than .05).

The public patient records were pulled from 110,312 Medicaid patient claims from Florida, Iowa, Kansas, Missouri, and New Jersey, with varying year ranges within the time period of 1997-2009. The private claims came from 36,529 patients with private insurance through their self-insured employers, and were gathered from Ingenix Employer records from 1999 to 2008.

The researchers selected only adult patients who had a prescription for an AED and who had been diagnosed with epilepsy or diagnosed with two nonfebrile seizures more than a month apart. All patients had been enrolled in their insurance plan for at least a year, and baseline included the 180 days before the patient’s first AED prescription. Patients were tracked until death, the end of continuous enrollment, or the end of the period for which data were available.

The study found that Medicaid and private patients with uncontrolled epilepsy had similarly higher incidence rate ratios (incidence rate defined as events divided by patient-years) of injury with 1.9-2.2 times more fractures and head injuries. Medicaid patients had 2.45 times more car accident injuries and 10 times more status epilepticus episodes.

Compared with patients who had well-controlled epilepsy, Medicaid patients had 1.94 times more AED prescriptions, 1.47 times more non-AED prescriptions, 6.65 times more hospitalizations, 7.72 times more days in the hospital, 3.67 times more ED visits, 1.66 times more outpatient services, and 3.09 times more neurologist visits. Likewise, private patients received 1.75 times more AED prescriptions, 1.34 times more non-AED prescriptions, 5.37 times more hospitalizations, 7.27 times more days in the hospital, 5.05 times more ED visits, 1.41 times more outpatient services, and 2.28 times more neurologist visits. (All P values were less than .05.)

Overall, Medicaid patients with uncontrolled epilepsy incurred an average $12,258 more in costs than Medicaid patients with well-controlled epilepsy, and uncontrolled epileptic private patients’ total extra cost was $14,582. Most of these costs came from hospitalization; outpatient services and prescription drugs comprised the next largest share. Private patients also missed 2.5 times more workdays, including 61% more sick days.

The study was limited by the conservative definition of epilepsy, the potential for unobservable confounders between cohorts, and the possibility that more uncontrolled patients existed who were not included because they did not require hospitalization or an ED visit.

The study was funded by GlaxoSmithKline, where Dr. Manjunath and another author are full-time employees. Five others are full-time employees of Analysis Group, which conducted the study with GSK’s grants, and another consults for Analysis Group.

Patients whose epilepsy was uncontrolled had more injuries, spent more time in the hospital, received more prescriptions, and incurred greater health care resource usage and costs than did patients whose epilepsy was under control in a retrospective, longitudinal matched-cohort study.

Additionally, uncontrolled epilepsy in private insurance patients incurred nearly $2,900 more in work time lost for disability and sick leave, comprising about one-fifth of these patients’ total direct health care costs.

Lead author Ranjani Manjunath of GlaxoSmithKline and her associates analyzed public and private insurance claims to determine how health care resource utilization and costs and epilepsy-related injuries differed between patients with uncontrolled epilepsy and those with well-controlled epilepsy. The findings were reported online Oct. 17 (Neurology 2012;79:1908-16).

The researchers defined patients with uncontrolled epilepsy as those who had at least two consecutive changes in their antiepileptic drug (AED) regimen (at least a month apart) and at least one subsequent hospitalization or emergency department visit within the next year. Patients taking AEDs but who had no changes in their therapy as well as no hospitalizations or ED visits were defined as having well-controlled epilepsy.

A total of 3,454 Medicaid patients and 602 private insurance patients with uncontrolled epilepsy were matched 1:1 with well-controlled epileptic patients for the study. Propensity score matching was used to reduce sample selection bias, and adjusted risk ratios for outcomes took into account age, sex, state or region, baseline AED use, use of other drugs known to increase seizure risk, baseline costs, and psychiatric conditions or epilepsy-related comorbidities (Alzheimer’s disease, brain tumor, meningitis, migraine, and stroke). A lower percentage of uncontrolled epilepsy patients were using AEDs at baseline: 48.1% of uncontrolled Medicaid patients, compared with 52.6% of well-controlled Medicaid patients (P less than .001), and 40% of uncontrolled private patients, compared with 45.5% of well-controlled private patients (P less than .05).

The public patient records were pulled from 110,312 Medicaid patient claims from Florida, Iowa, Kansas, Missouri, and New Jersey, with varying year ranges within the time period of 1997-2009. The private claims came from 36,529 patients with private insurance through their self-insured employers, and were gathered from Ingenix Employer records from 1999 to 2008.

The researchers selected only adult patients who had a prescription for an AED and who had been diagnosed with epilepsy or diagnosed with two nonfebrile seizures more than a month apart. All patients had been enrolled in their insurance plan for at least a year, and baseline included the 180 days before the patient’s first AED prescription. Patients were tracked until death, the end of continuous enrollment, or the end of the period for which data were available.

The study found that Medicaid and private patients with uncontrolled epilepsy had similarly higher incidence rate ratios (incidence rate defined as events divided by patient-years) of injury with 1.9-2.2 times more fractures and head injuries. Medicaid patients had 2.45 times more car accident injuries and 10 times more status epilepticus episodes.

Compared with patients who had well-controlled epilepsy, Medicaid patients had 1.94 times more AED prescriptions, 1.47 times more non-AED prescriptions, 6.65 times more hospitalizations, 7.72 times more days in the hospital, 3.67 times more ED visits, 1.66 times more outpatient services, and 3.09 times more neurologist visits. Likewise, private patients received 1.75 times more AED prescriptions, 1.34 times more non-AED prescriptions, 5.37 times more hospitalizations, 7.27 times more days in the hospital, 5.05 times more ED visits, 1.41 times more outpatient services, and 2.28 times more neurologist visits. (All P values were less than .05.)

Overall, Medicaid patients with uncontrolled epilepsy incurred an average $12,258 more in costs than Medicaid patients with well-controlled epilepsy, and uncontrolled epileptic private patients’ total extra cost was $14,582. Most of these costs came from hospitalization; outpatient services and prescription drugs comprised the next largest share. Private patients also missed 2.5 times more workdays, including 61% more sick days.

The study was limited by the conservative definition of epilepsy, the potential for unobservable confounders between cohorts, and the possibility that more uncontrolled patients existed who were not included because they did not require hospitalization or an ED visit.

The study was funded by GlaxoSmithKline, where Dr. Manjunath and another author are full-time employees. Five others are full-time employees of Analysis Group, which conducted the study with GSK’s grants, and another consults for Analysis Group.

Patients whose epilepsy was uncontrolled had more injuries, spent more time in the hospital, received more prescriptions, and incurred greater health care resource usage and costs than did patients whose epilepsy was under control in a retrospective, longitudinal matched-cohort study.

Additionally, uncontrolled epilepsy in private insurance patients incurred nearly $2,900 more in work time lost for disability and sick leave, comprising about one-fifth of these patients’ total direct health care costs.

Lead author Ranjani Manjunath of GlaxoSmithKline and her associates analyzed public and private insurance claims to determine how health care resource utilization and costs and epilepsy-related injuries differed between patients with uncontrolled epilepsy and those with well-controlled epilepsy. The findings were reported online Oct. 17 (Neurology 2012;79:1908-16).

The researchers defined patients with uncontrolled epilepsy as those who had at least two consecutive changes in their antiepileptic drug (AED) regimen (at least a month apart) and at least one subsequent hospitalization or emergency department visit within the next year. Patients taking AEDs but who had no changes in their therapy as well as no hospitalizations or ED visits were defined as having well-controlled epilepsy.

A total of 3,454 Medicaid patients and 602 private insurance patients with uncontrolled epilepsy were matched 1:1 with well-controlled epileptic patients for the study. Propensity score matching was used to reduce sample selection bias, and adjusted risk ratios for outcomes took into account age, sex, state or region, baseline AED use, use of other drugs known to increase seizure risk, baseline costs, and psychiatric conditions or epilepsy-related comorbidities (Alzheimer’s disease, brain tumor, meningitis, migraine, and stroke). A lower percentage of uncontrolled epilepsy patients were using AEDs at baseline: 48.1% of uncontrolled Medicaid patients, compared with 52.6% of well-controlled Medicaid patients (P less than .001), and 40% of uncontrolled private patients, compared with 45.5% of well-controlled private patients (P less than .05).

The public patient records were pulled from 110,312 Medicaid patient claims from Florida, Iowa, Kansas, Missouri, and New Jersey, with varying year ranges within the time period of 1997-2009. The private claims came from 36,529 patients with private insurance through their self-insured employers, and were gathered from Ingenix Employer records from 1999 to 2008.

The researchers selected only adult patients who had a prescription for an AED and who had been diagnosed with epilepsy or diagnosed with two nonfebrile seizures more than a month apart. All patients had been enrolled in their insurance plan for at least a year, and baseline included the 180 days before the patient’s first AED prescription. Patients were tracked until death, the end of continuous enrollment, or the end of the period for which data were available.

The study found that Medicaid and private patients with uncontrolled epilepsy had similarly higher incidence rate ratios (incidence rate defined as events divided by patient-years) of injury with 1.9-2.2 times more fractures and head injuries. Medicaid patients had 2.45 times more car accident injuries and 10 times more status epilepticus episodes.

Compared with patients who had well-controlled epilepsy, Medicaid patients had 1.94 times more AED prescriptions, 1.47 times more non-AED prescriptions, 6.65 times more hospitalizations, 7.72 times more days in the hospital, 3.67 times more ED visits, 1.66 times more outpatient services, and 3.09 times more neurologist visits. Likewise, private patients received 1.75 times more AED prescriptions, 1.34 times more non-AED prescriptions, 5.37 times more hospitalizations, 7.27 times more days in the hospital, 5.05 times more ED visits, 1.41 times more outpatient services, and 2.28 times more neurologist visits. (All P values were less than .05.)

Overall, Medicaid patients with uncontrolled epilepsy incurred an average $12,258 more in costs than Medicaid patients with well-controlled epilepsy, and uncontrolled epileptic private patients’ total extra cost was $14,582. Most of these costs came from hospitalization; outpatient services and prescription drugs comprised the next largest share. Private patients also missed 2.5 times more workdays, including 61% more sick days.

The study was limited by the conservative definition of epilepsy, the potential for unobservable confounders between cohorts, and the possibility that more uncontrolled patients existed who were not included because they did not require hospitalization or an ED visit.

The study was funded by GlaxoSmithKline, where Dr. Manjunath and another author are full-time employees. Five others are full-time employees of Analysis Group, which conducted the study with GSK’s grants, and another consults for Analysis Group.

Metabolic syndrome in patients with schizophrenia and other nonaffective psychoses is associated with a higher total and differential white blood cell count, increased high-sensitivity C-reactive protein levels, and higher monocyte levels, a small cross-sectional study shows.

The study also found that high-sensitivity C-reactive proteins (hs-CRPs) predicted two of the criteria for metabolic syndrome: an increased waist circumference and increased triglycerides, and both monocytes and lymphocytes were associated with increased triglycerides (all P values under .05).

Past research already had shown that schizophrenia patients were at an increased risk for metabolic syndrome, a combination of multiple factors that increase a person’s risk of developing cardiovascular disease. CVD is a leading killer of patients with nonaffective psychoses. Both schizophrenia and metabolic syndrome are associated with increased inflammation, and several studies have found associations between white blood cell (WBC) counts and metabolic syndrome.

Therefore, Dr. Brian J. Miller and his associates at Georgia Health Sciences University in Augusta, examined "the relationship between total and differential WBC counts, hs-CRP, and the metabolic syndrome in patients with schizophrenia and related nonaffective psychosis and in controls." The findings were published online Sept. 11 ahead of print (Brain Behav. Immun. 2012 [doi:10.1016/j.bbi.2012.08.016]).

At baseline, 59 inpatients and outpatients, aged 18-70 years, and 22 controls with no history of schizophrenia or mood disorders were assessed for psychosis and mood disorders using the Structured Clinical Interview for DSM-IV disorders. Participants with a range of conditions – including pregnancy, alcohol withdrawal, diabetes, recent surgery, recent drug use or current use of immunomodulatory agents, lipid-lowering therapies or antibiotics – were excluded. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate patient symptoms. While four raters did the interviews for the subjects, a 100% concordance was achieved during prior training to ensure inter-rater reliability.

Among the patients, 39 had schizophrenia, 15 had schizoaffective disorder, 1 had brief psychotic disorder, and 4 had psychotic disorders not otherwise specified. Measurements of all participants also were taken for height, weight, waist circumference, and hip circumference. Their vital signs and a morning blood draw (between 8 and 9 a.m. after a 10-hour fast) also were taken to gather complete blood counts, fasting serum glucose, and a lipid panels analysis.

A total of 32% of the patients and 23% of the control group had metabolic syndrome based on having three or more of the five criteria: a waist circumference greater than or equal to 102 cm in males and greater than or equal to 88 cm in females; fasting triglycerides greater than or equal to 150 mg/dL; fasting HDL less than 40 mg/dL in males or less than 50 mg/dL in females; blood pressure greater than or equal to 130/85 mmHg (or taking medication to manage a history of hypertension); and a fasting glucose over greater than or equal to 100 mg/dL (or taking medication for increased glucose levels).

Using binary logistic regression models, the authors calculated how predictive the participants’ WBC counts, hs-CRP levels, monocytes, and lymphocytes were of metabolic syndrome and its criteria. The associations they found remained after controlling for age, sex, race, smoking, parental history of diabetes, age at first hospitalization for psychosis, and current psychotropic medications. (Only four patients were not taking antipsychotics, and 27% were taking risperidone.) The link between WBC counts, hs-CRP, and monocytes with metabolic syndrome existed for the controls as well, but those results did not achieve statistical power because of the small sample size.

"Taken together, our results contribute to a growing body of evidence for an association between inflammation and the metabolic syndrome in nonaffective psychoses," the authors reported. Their findings were limited by the study’s small size, mix of inpatients and outpatients, and diversity in patient treatments.

Consensus guidelines from the American Psychiatric Association and the American Diabetes Association recommend metabolic monitoring of patients taking antipsychotics. Yet "monitoring rates in clinical practice remain alarmingly low," and the researchers suggest taking account of patients’ WBC counts and hs-CRP levels. If their findings are replicated through further research, the researchers said, the cardiovascular risk of patients with nonaffective psychoses such as schizophrenia might be reduced if the patients were prescribed statins or another anti-inflammatory drug.

Dr. Miller reported receiving grant support from several sources, including the National Institutes of Health and Oy H. Lundbeck Ab; consultancy fees on behalf of Genentech/Roche; and speaker fees from the Maryland Psychiatric Research Center.

Metabolic syndrome in patients with schizophrenia and other nonaffective psychoses is associated with a higher total and differential white blood cell count, increased high-sensitivity C-reactive protein levels, and higher monocyte levels, a small cross-sectional study shows.

The study also found that high-sensitivity C-reactive proteins (hs-CRPs) predicted two of the criteria for metabolic syndrome: an increased waist circumference and increased triglycerides, and both monocytes and lymphocytes were associated with increased triglycerides (all P values under .05).

Past research already had shown that schizophrenia patients were at an increased risk for metabolic syndrome, a combination of multiple factors that increase a person’s risk of developing cardiovascular disease. CVD is a leading killer of patients with nonaffective psychoses. Both schizophrenia and metabolic syndrome are associated with increased inflammation, and several studies have found associations between white blood cell (WBC) counts and metabolic syndrome.

Therefore, Dr. Brian J. Miller and his associates at Georgia Health Sciences University in Augusta, examined "the relationship between total and differential WBC counts, hs-CRP, and the metabolic syndrome in patients with schizophrenia and related nonaffective psychosis and in controls." The findings were published online Sept. 11 ahead of print (Brain Behav. Immun. 2012 [doi:10.1016/j.bbi.2012.08.016]).

At baseline, 59 inpatients and outpatients, aged 18-70 years, and 22 controls with no history of schizophrenia or mood disorders were assessed for psychosis and mood disorders using the Structured Clinical Interview for DSM-IV disorders. Participants with a range of conditions – including pregnancy, alcohol withdrawal, diabetes, recent surgery, recent drug use or current use of immunomodulatory agents, lipid-lowering therapies or antibiotics – were excluded. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate patient symptoms. While four raters did the interviews for the subjects, a 100% concordance was achieved during prior training to ensure inter-rater reliability.

Among the patients, 39 had schizophrenia, 15 had schizoaffective disorder, 1 had brief psychotic disorder, and 4 had psychotic disorders not otherwise specified. Measurements of all participants also were taken for height, weight, waist circumference, and hip circumference. Their vital signs and a morning blood draw (between 8 and 9 a.m. after a 10-hour fast) also were taken to gather complete blood counts, fasting serum glucose, and a lipid panels analysis.

A total of 32% of the patients and 23% of the control group had metabolic syndrome based on having three or more of the five criteria: a waist circumference greater than or equal to 102 cm in males and greater than or equal to 88 cm in females; fasting triglycerides greater than or equal to 150 mg/dL; fasting HDL less than 40 mg/dL in males or less than 50 mg/dL in females; blood pressure greater than or equal to 130/85 mmHg (or taking medication to manage a history of hypertension); and a fasting glucose over greater than or equal to 100 mg/dL (or taking medication for increased glucose levels).

Using binary logistic regression models, the authors calculated how predictive the participants’ WBC counts, hs-CRP levels, monocytes, and lymphocytes were of metabolic syndrome and its criteria. The associations they found remained after controlling for age, sex, race, smoking, parental history of diabetes, age at first hospitalization for psychosis, and current psychotropic medications. (Only four patients were not taking antipsychotics, and 27% were taking risperidone.) The link between WBC counts, hs-CRP, and monocytes with metabolic syndrome existed for the controls as well, but those results did not achieve statistical power because of the small sample size.

"Taken together, our results contribute to a growing body of evidence for an association between inflammation and the metabolic syndrome in nonaffective psychoses," the authors reported. Their findings were limited by the study’s small size, mix of inpatients and outpatients, and diversity in patient treatments.

Consensus guidelines from the American Psychiatric Association and the American Diabetes Association recommend metabolic monitoring of patients taking antipsychotics. Yet "monitoring rates in clinical practice remain alarmingly low," and the researchers suggest taking account of patients’ WBC counts and hs-CRP levels. If their findings are replicated through further research, the researchers said, the cardiovascular risk of patients with nonaffective psychoses such as schizophrenia might be reduced if the patients were prescribed statins or another anti-inflammatory drug.

Dr. Miller reported receiving grant support from several sources, including the National Institutes of Health and Oy H. Lundbeck Ab; consultancy fees on behalf of Genentech/Roche; and speaker fees from the Maryland Psychiatric Research Center.

Metabolic syndrome in patients with schizophrenia and other nonaffective psychoses is associated with a higher total and differential white blood cell count, increased high-sensitivity C-reactive protein levels, and higher monocyte levels, a small cross-sectional study shows.

The study also found that high-sensitivity C-reactive proteins (hs-CRPs) predicted two of the criteria for metabolic syndrome: an increased waist circumference and increased triglycerides, and both monocytes and lymphocytes were associated with increased triglycerides (all P values under .05).

Past research already had shown that schizophrenia patients were at an increased risk for metabolic syndrome, a combination of multiple factors that increase a person’s risk of developing cardiovascular disease. CVD is a leading killer of patients with nonaffective psychoses. Both schizophrenia and metabolic syndrome are associated with increased inflammation, and several studies have found associations between white blood cell (WBC) counts and metabolic syndrome.

Therefore, Dr. Brian J. Miller and his associates at Georgia Health Sciences University in Augusta, examined "the relationship between total and differential WBC counts, hs-CRP, and the metabolic syndrome in patients with schizophrenia and related nonaffective psychosis and in controls." The findings were published online Sept. 11 ahead of print (Brain Behav. Immun. 2012 [doi:10.1016/j.bbi.2012.08.016]).

At baseline, 59 inpatients and outpatients, aged 18-70 years, and 22 controls with no history of schizophrenia or mood disorders were assessed for psychosis and mood disorders using the Structured Clinical Interview for DSM-IV disorders. Participants with a range of conditions – including pregnancy, alcohol withdrawal, diabetes, recent surgery, recent drug use or current use of immunomodulatory agents, lipid-lowering therapies or antibiotics – were excluded. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate patient symptoms. While four raters did the interviews for the subjects, a 100% concordance was achieved during prior training to ensure inter-rater reliability.

Among the patients, 39 had schizophrenia, 15 had schizoaffective disorder, 1 had brief psychotic disorder, and 4 had psychotic disorders not otherwise specified. Measurements of all participants also were taken for height, weight, waist circumference, and hip circumference. Their vital signs and a morning blood draw (between 8 and 9 a.m. after a 10-hour fast) also were taken to gather complete blood counts, fasting serum glucose, and a lipid panels analysis.

A total of 32% of the patients and 23% of the control group had metabolic syndrome based on having three or more of the five criteria: a waist circumference greater than or equal to 102 cm in males and greater than or equal to 88 cm in females; fasting triglycerides greater than or equal to 150 mg/dL; fasting HDL less than 40 mg/dL in males or less than 50 mg/dL in females; blood pressure greater than or equal to 130/85 mmHg (or taking medication to manage a history of hypertension); and a fasting glucose over greater than or equal to 100 mg/dL (or taking medication for increased glucose levels).

Using binary logistic regression models, the authors calculated how predictive the participants’ WBC counts, hs-CRP levels, monocytes, and lymphocytes were of metabolic syndrome and its criteria. The associations they found remained after controlling for age, sex, race, smoking, parental history of diabetes, age at first hospitalization for psychosis, and current psychotropic medications. (Only four patients were not taking antipsychotics, and 27% were taking risperidone.) The link between WBC counts, hs-CRP, and monocytes with metabolic syndrome existed for the controls as well, but those results did not achieve statistical power because of the small sample size.

"Taken together, our results contribute to a growing body of evidence for an association between inflammation and the metabolic syndrome in nonaffective psychoses," the authors reported. Their findings were limited by the study’s small size, mix of inpatients and outpatients, and diversity in patient treatments.

Consensus guidelines from the American Psychiatric Association and the American Diabetes Association recommend metabolic monitoring of patients taking antipsychotics. Yet "monitoring rates in clinical practice remain alarmingly low," and the researchers suggest taking account of patients’ WBC counts and hs-CRP levels. If their findings are replicated through further research, the researchers said, the cardiovascular risk of patients with nonaffective psychoses such as schizophrenia might be reduced if the patients were prescribed statins or another anti-inflammatory drug.

Dr. Miller reported receiving grant support from several sources, including the National Institutes of Health and Oy H. Lundbeck Ab; consultancy fees on behalf of Genentech/Roche; and speaker fees from the Maryland Psychiatric Research Center.