Liam Davenport

June 22, 2017

COPENHAGEN, Denmark ― Even young patients with early-onset psychosis experience metabolic changes, as evidenced by elevations in lipid levels, say Norwegian scientists in findings that lend further weight to the theory that cardiovascular disease (CVD) risk factors and schizophrenia share common roots.

The study of lean teenagers with early-onset psychosis showed that lipid levels were significantly increased in medication-naive patients, although the effect was more pronounced in those who had already started treatment.

"The finding of subclinical dyslipidemia in young, lean, early-onset psychosis patients predating medication suggests that metabolic alterations might be attributed to the underlying disease itself. Clinicians need to be aware of the risk of lipid abnormalities in early-onset psychosis patients and treat adequately if metabolic syndrome develops," the investigators, led by Kirsten Wedervang-Resell, MD, PhD candidate, Oslo University Hospital, Norway, write.

The findings were presented here at the 13th World Congress of Biological Psychiatry.

CVD, Psychosis: Shared Roots?

Although the increased risk for CVD and metabolic syndrome in patients with schizophrenia may result from an unhealthy diet, sedentary lifestyle, and the adverse effects of antipsychotic medications, previous research suggests there is a genetic overlap between CVD risk factors and schizophrenia.

In younger patients with psychosis, the duration of illness is shorter and exposure to medication is limited. The researchers examined the association by studying lipid profiles in lean patients aged 12 to 18 years with early-onset psychosis.

Their study included 28 patients and 53 control participants who were matched for age and catchment area. Fasting plasma lipid levels and serum glucose levels were measured using standard methods. Fasting serum insulin samples were used to calculate the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index.

The mean age of the patients was 16.3 years, and 73% were female. The mean body mass index was 21.7 kg/m2, and 26.3% were smokers. Medication exposure was recorded in 64.3% of patients.

There were no significant differences in baseline characteristics between patients and control participants except that patients were substantially more likely to be smoke cannabis, at 23.7% vs 1.7% (P < .001), and for patients, mean scores on the Children's Global Assessment Scale were significantly lower, at 42.5 vs 90.4 (P < .001).

Compared with healthy control persons, total cholesterol levels were significantly higher for both medication-exposed and medication-naive patients (P < .001 and P < .05, respectively).

A similar pattern was observed with respect to low-density lipoprotein cholesterol levels: significantly higher levels were seen in medication-exposed and medication-naive patients vs control persons (P < .01 and P < .05, respectively). Triglyceride levels were also significantly higher in medication-exposed and medication-naive patients (P < .001 and P < .05, respectively).

There were no significant differences between patients and control persons in high-density lipoprotein, glucose, and insulin levels or in the HOMA-IR index.

Wedervang-Resell told Medscape Medical News that the results not only help inform clinicians treating younger psychosis patients but also illuminate the underlying associations between CVD risk factors and schizophrenia.

"That is how I interpret it: that it's both a clinical implication and has a scientific implication. Maybe it will add to the growing literature of lipid biology playing a role in the pathophysiology of schizophrenia, at least for a subgroup of [these patients]," she said.

There is also the possibility that lipid alterations early in psychosis could point to novel treatment targets in the future.

"The schizophrenia group is obviously a very heterogeneous group, and probably it's not only the dopamine theory that's important. I hope that we can find some new medications in the future," said Wedervang-Resell.

Poster discussant Massimiliano Buoli, MD, assistant professor, Department of Psychiatry, University of Milan, Italy, told Medscape Medical News that the findings are "very important because, independently from the antipsychotic drugs that we know are associated with metabolic syndrome and diabetes, we know now with this research that there is an independent predisposition to dysmetabolism in these patients."

He added that this means that now "clinicians will have to take care of these parameters in these patients [with early-onset psychosis]."

No funding for the study has been disclosed. The investigators have disclosed no relevant financial relationships.

13th World Congress of Biological Psychiatry. Poster P-07-001, presented June 20, 2017.


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