Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial

May combine two claims.

There were no significant differences in overall rates of dyslipidaemia (p = 0.545), hypertension (p = 0.101), diabetes (p = 0.298) and obesity (BMI > 30 kg/m2) (p = 0.140) by ethnicity.

“However, there were no significant differences in overall rates of dyslipidaemia (p = 0.545), hypertension (p = 0.101), diabetes (p = 0.298) and obesity (BMI > 30 kg/m2) (p = 0.140).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In respect of ethnicity, 55% (n = 239) were of Caucasian ethnicity, 33% (n = 143) were of black African or black Caribbean ethnicity, with 7% (n = 27) of Asian ethnicity and 5% (n = 22) of mixed ethnicity.

“In respect of ethnicity, 55% (n = 239) were of Caucasian ethnicity, while 33% (n = 143) were of black African or black Caribbean ethnicity, with 7% (n = 27) of Asian ethnicity and 5% (n = 22) of mixed ethnicity.”

May combine two claims.

Hypertension was present in 214/398 (54%), of whom 62 were on anti-hypertensive therapy.

“Hypertension was present in 214/398 (54%), of whom 62 were on anti-hypertensive therapy.”

May combine two claims.

There was no relationship between duration of psychotic illness and any of obesity (BMI > 30 kg/m2) (t = 0.410, df = 329, p = 0.682), hypertension (t = −1.346, p = 0.179), dyslipidaemia (t = −0.144, p = 0.886) or presence of diabetes mellitus (t = −0.992, df = 251, p = 0.322).

“There was no relationship between duration of psychotic illness and any of obesity (BMI > 30 kg/m2) (t = 0.410, df = 329, p = 0.682), hypertension (t = −1.346, p = 0.179), dyslipidaemia (t = −0.144, p = 0.886) or presence of diabetes mellitus (t = −0.992, df = 251, p = 0.322).”

May combine two claims.

Mean age of the study population was 43.6 years (s.d. = 10.1) and mean duration of illness was 15.7 years (s.d. = 10.3).

“Mean age was 43.6 years (s.d. = 10.1) and mean duration of illness was 15.7 years (s.d. = 10.3); 57% (n = 257) were male.”

Probably not a substantial claim: may not pass S3 (load-bearing).

57% (n = 257) of the study population were male.

“Mean age was 43.6 years (s.d. = 10.1) and mean duration of illness was 15.7 years (s.d. = 10.3); 57% (n = 257) were male.”

May combine two claims.

Of the participants, 30% (n = 127) were prescribed clozapine and 16% (n = 70) olanzapine.

“Of the participants, 30% (n = 127) were prescribed clozapine and 16% (n = 70) olanzapine.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There was no significant difference between mean BMI and waist circumference when stratified by geographical location (by borough).

“There was no significant difference between mean BMI (p = 0.241) and waist circumference (p = 0.437) when stratified by geographical location (by borough).”

May combine two claims.

Of the participants, 75% (n = 321) were treated with second-generation (atypical) antipsychotics (including clozapine and olanzapine), 16% (n = 71) were treated with first-generation antipsychotics and 8% (n = 36) were treated with a combination of antipsychotics.

“Of the participants, 75% (n = 321) were treated with second-generation (atypical) antipsychotics (including clozapine and olanzapine), 16% (n = 71) were treated with first-generation antipsychotics and 8% (n = 36) were treated with a combination of antipsychotics.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of patients screened, 39% (1043/2663) met the inclusion criteria, with the majority excluded for not meeting the diagnostic inclusion criterion.

“Of patients screened, 39% (1043/2663) met the inclusion criteria, with the majority excluded for not meeting the diagnostic inclusion criterion (though the exact percentage excluded by each exclusion criterion is not known).”

May combine two claims.

There was no difference in duration of illness (p = 0.358), or the use of clozapine (p = 0.282) or olanzapine (p = 0.303) in those with IDF MetS compared with those without.

“There was no difference in duration of illness (p = 0.358), or the use of clozapine (p = 0.282) or olanzapine (p = 0.303) in those with IDF MetS compared with those without.”

May combine two claims.

Of the subjects, 62% (268/432) smoked tobacco, smoking an average of 18.2 (s.d. = 11.6) cigarettes per day.

“Of the subjects, 62% (268/432) smoked tobacco, smoking an average of 18.2 (s.d. = 11.6) cigarettes per day.”

May combine two claims.

Engaging in high levels of physical activity was associated with lower rates of obesity (χ2 = 20.944, p < 0.0001) and dyslipidaemia (χ2 = 17.537, p = 0.001) compared with low-intensity physical activity.

“Engaging in high levels of physical activity was associated with lower rates of obesity (χ2 = 20.944, p < 0.0001) and dyslipidaemia (χ2 = 17.537, p = 0.001) compared with low-intensity physical activity.”

May combine two claims.

Of the respondents, 28% (n = 68/291) had hazardous/harmful alcohol use (AUDIT score ≥ 8), while the alcohol intake of a further 4% (n = 12/291) indicated the need for diagnostic evaluation for alcohol dependence syndrome (AUDIT score ≥ 20).

“Of the respondents, 28% (n = 68/291) had hazardous/harmful alcohol use (AUDIT score ≥ 8), while the alcohol intake of a further 4% (n = 12/291) indicated the need for diagnostic evaluation for alcohol dependence syndrome (AUDIT score ≥ 20).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of the participants, 3% (n = 13/439) were cocaine or amphetamine users, 1.4% (n = 6) reported ongoing crack cocaine use and less than 1% (n = 3) reported using ecstasy.

“Of the participants, 3% (n = 13/439) were cocaine or amphetamine users, 1.4% (n = 6) reported ongoing crack cocaine use and less than 1% (n = 3) reported using ecstasy.”

May combine two claims.

Of the participants, 44% (n = 196) were engaging in low-intensity physical activity, 44% (n = 200) engaged in moderate-intensity physical activity, while 12% (n = 54) participated in high-intensity physical activity.

“Of the participants, 44% (n = 196) were engaging in low-intensity physical activity, 44% (n = 200) engaged in moderate-intensity physical activity, while 12% (n = 54) participated in high-intensity physical activity.”

May combine two claims.

Of the participants, 23% (102/435) had a high saturated fat intake score on the DINE, 29.7% (129/435) had a medium fat intake, while 47% (204/435) had a low saturated fat intake; 51% of the participants (n = 210) had a low fibre intake, with only 25% (n = 102) reporting a high fibre intake.

“Of the participants, 23% (102/435) had a high saturated fat intake score on the DINE, 29.7% (129/435) had a medium fat intake, while 47% (204/435) had a low saturated fat intake; 51% of the participants (n = 210) had a low fibre intake, with only 25% (n = 102) reporting a high fibre intake.”

May combine two claims.

Of the respondents, 18% (n = 76/422) were current cannabis users, with 52 people identified through the Timeline Follow-Back procedure and a further 24 identified through a cannabinoid-positive urinary drug screen.

“Of the respondents, 18% (n = 76/422) were current cannabis users, with 52 people identified through the Timeline Follow-Back procedure and a further 24 identified through a cannabinoid-positive urinary drug screen.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The pooled relative risk of mortality among those with psychoses is 2.54 (2.35-2.75) times that of the general population.

“A recent meta-analysis has demonstrated that the pooled relative risk of mortality among those with psychoses is 2.54 (2.35–2.75) times that of the general population, and higher rates of mortality for those with psychoses when compared with depressive and anxiety disorders (Walker et al. 2015).”

• cites Walker et al. 2015Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A recent meta-analysis of international studies reported prevalence rates of 44% for central obesity, 19.5% for hyperglycaemia, 10.9% for diabetes, 39% for hypertension and 39% for dyslipidaemias, with rates increasing with age.

“A recent meta-analysis of international studies reported prevalence rates of 44% for central obesity, 19.5% for hyperglycaemia, 10.9% for diabetes, 39% for hypertension and 39% for dyslipidaemias, with rates increasing with age (Mitchell et al. 2013).”

• cites Mitchell et al. 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

On meta-analysis, a third of patients with schizophrenia have the MetS, with this proportion increasing with duration of illness.

“On meta-analysis, a third of patients with schizophrenia have the MetS, with this proportion increasing with duration of illness (Mitchell et al. 2013).”

• cites Mitchell et al. 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The deficit syndrome in schizophrenia is in itself associated with higher CVD risk.

“while the deficit syndrome (i.e. negative symptoms of psychosis that are present as enduring traits) in schizophrenia is in itself associated with higher CVD risk (Arango et al. 2011).”

• cites Arango et al. 2011Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Similar rates of the MetS have been observed in bipolar disorder (37%) and schizo-affective disorder (27-42%).

“Similar rates of the MetS have been observed in bipolar disorder (37%) (Vancampfort et al. 2013a) and schizo-affective disorder (27–42%) (Basu et al. 2004; Bobes et al. 2012), although recently the Second Australian National Survey of Psychosis reported higher rates of 61% in those with psychotic disorders, suggesting an increasing prevalence with time (Morgan et al. 2014).”

• cites Vancampfort et al. 2013aNot checked yet

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• cites Basu et al. 2004Not checked yet

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• cites Bobes et al. 2012Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Individuals with the MetS have a 3- to 6-fold increased risk of developing type 2 diabetes mellitus.

“Individuals with the MetS have a 3- to 6-fold increased risk of developing type 2 diabetes mellitus (Hanley et al. 2005; De Hert et al. 2011) and a 2- to 6-fold risk of mortality due to cardiovascular disease (CVD) (Hanley et al. 2005).”

• cites Hanley et al. 2005Not checked yet

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• cites De Hert et al. 2011Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Individuals with the MetS have a 2- to 6-fold risk of mortality due to cardiovascular disease.

“Individuals with the MetS have a 3- to 6-fold increased risk of developing type 2 diabetes mellitus (Hanley et al. 2005; De Hert et al. 2011) and a 2- to 6-fold risk of mortality due to cardiovascular disease (CVD) (Hanley et al. 2005).”

• cites Hanley et al. 2005Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The diagnosis of a psychotic illness such as schizophrenia or bipolar disorder is associated with a reduced life expectancy of 15-25 years, mostly due to increased cardiovascular deaths.

“The diagnosis of a psychotic illness such as schizophrenia or bipolar disorder is associated with a reduced life expectancy of 15–25 years, mostly due to increased cardiovascular deaths (Saha et al. 2007; Kilbourne et al. 2009; Brown et al. 2010; Chang et al. 2011).”

• cites Saha et al. 2007Not checked yet

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• cites Kilbourne et al. 2009Not checked yet

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• cites Brown et al. 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Slightly higher MetS rates of 34% are seen in multi-episode patients.

“Slightly higher MetS rates of 34% are seen in multi-episode patients (Vancampfort et al. 2013b) while the deficit syndrome (i.e. negative symptoms of psychosis that are present as enduring traits) in schizophrenia is in itself associated with higher CVD risk (Arango et al. 2011).”

• cites Vancampfort et al. 2013bNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Various UK medical Royal colleges have recently agreed joint management strategies for CVD risk in psychotic illnesses.

“Encouragingly, various UK medical Royal colleges have recently agreed joint management strategies for CVD risk in psychotic illnesses (Lester et al. 2014).”

• cites Lester et al. 2014Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Participants' mental health status was measured using the Positive And Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) and the Montgomery-Åsberg Depression Rating Scale (MADRS).

“Participants’ mental health status was measured using the Positive And Negative Syndrome Scale (PANSS; Kay et al. 1989), the Global Assessment of Functioning (GAF; American Psychiatric Association, 2002) and the Montgomery–Åsberg Depression Rating Scale (MADRS; Montgomery & Åsberg, 1979).”

• cites Kay et al. 1989 sourceNot checked yet

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• cites American Psychiatric Association, 2002Not checked yet

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• cites Montgomery & Åsberg, 1979Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

It is possible to prevent the emergence of CVD risk in psychosis with the use of psychosocial interventions in the short term, though this is not sustained once the intervention is discontinued.

“It is possible to prevent the emergence of CVD risk in psychosis with the use of psychosocial interventions in the short term, though this is not sustained once the intervention is discontinued (Alvarez-Jimenez et al. 2010).”

• cites Alvarez-Jimenez et al. 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Data for all measures were collected through face-to-face interviews conducted by trained research assistants.

“Data for all measures were collected through face-to-face interviews conducted by trained research assistants.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Dietary Instrument for Nutrition Education (DINE) was used to assess the dietary patterns of participants over the past week.

“The Dietary Instrument for Nutrition Education (DINE; Roe et al. 1994) was used to assess the dietary patterns of participants over the past week.”

• cites Roe et al. 1994Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Potential participants were identified through their care-coordinator and approached in a random sequence.

“Potential participants were identified through their care-coordinator. All care-coordinators in participating CMHTs were approached in a random sequence and invited to participate. Patients on each participating care coordinator's caseload, meeting the inclusion criteria, were likewise approached in a random order.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Second Australian National Survey of Psychosis reported higher rates of 61% in those with psychotic disorders, suggesting an increasing prevalence with time.

“although recently the Second Australian National Survey of Psychosis reported higher rates of 61% in those with psychotic disorders, suggesting an increasing prevalence with time (Morgan et al. 2014).”

• cites Morgan et al. 2014Not checked yet

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Classified as probably not a substantial claim.

Fasting blood samples were taken because serum glucose and triglycerides are affected by recent food ingestion.

“As both serum glucose and triglycerides are affected by recent food ingestion, we took fasting blood samples.”

Classified as probably not a substantial claim.

Height, weight and blood pressure were measured using standardized techniques.

“Height, weight and blood pressure (BP) were measured using standardized techniques.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The International Physical Activity Questionnaire was used to measure the intensity and duration of physical activity over the previous week.

“The International Physical Activity Questionnaire was used to measure the intensity of physical activity (high, moderate, low) and the duration of physical activities over the previous week (Craig et al. 2003).”

• cites Craig et al. 2003Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Current alcohol, smoking and cannabis use was recorded using the Alcohol Use Disorders Identification Test (AUDIT), the Nicotine Dependence Questionnaire, Timeline Follow-Back and a urine drug screen.

“Current alcohol, smoking and cannabis use was recorded using the following measures: the Alcohol Use Disorders Identification Test (AUDIT; Saunders et al. 1993); the Nicotine Dependence Questionnaire (Fagerstrom, 1978; Fagerstrom & Schneider, 1989); Timeline Follow-Back (Sobell & Sobell, 1992); and a urine drug screen.”

• cites Saunders et al. 1993Not checked yet

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• cites Fagerstrom, 1978Not checked yet

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• cites Fagerstrom & Schneider, 1989Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Waist circumference was measured at the umbilicus with the patient standing.

“Waist circumference was measured at the umbilicus with the patient standing.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Blood pressure values presented are the second BP measurements, taken after an interval of 5 min.

“The BP values presented are the second BP measurements, taken after an interval of 5 min.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study took place in community mental health teams in five Mental Health NHS Trusts, covering urban and rural boroughs across England.

“The study took place in community mental health teams (CMHTs) in five Mental Health NHS Trusts, covering urban (Lambeth, Southwark, Lewisham, Croydon, Greenwich, Bexley, Bromley) and rural (Staffordshire, Somerset and Sussex) boroughs across England (Gaughran et al. 2013).”

• cites Gaughran et al. 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Strategies do exist to manage established cardiometabolic risk factors.

“Strategies do exist to manage established cardiometabolic risk factors (Lester et al. 2014), but despite this, a recent UK national audit reported screening rates for metabolic side effects of antipsychotic medication of only 11% (Barnes et al. 2007).”

• cites Lester et al. 2014Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The recent Schizophrenia Commission Report (UK) highlighted the disparity of care for individuals with psychosis and emphasized the need for improved physical health intervention.

“The recent Schizophrenia Commission Report (UK) highlighted the disparity of care for individuals with psychosis and emphasized the need for improved physical health intervention (Schizophrenia Commission, 2012).”

• cites Schizophrenia Commission, 2012Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

A recent meta-analysis of MetS in schizophrenia found a lack of homogeneity in the distribution of MetS prevalence across individual studies.

“This meta-analysis found a lack of homogeneity in the distribution of MetS prevalence across individual studies.”

• cites Mitchell et al. 2013Not checked yet

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May combine two claims.

In the US CATIE study, the PANSS mean total score was 75.9, higher than in IMPaCT (51.2), and NCEP ATP-III MetS rates were lower in CATIE (36%) compared with IMPaCT (56%).

“Of note, in the US Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, the PANSS mean total score of 75.9 was higher than in IMPaCT (51.2) – with lower NCEP ATP-III MetS rates of 36% in CATIE compared with the ATP-III MetS rate of 56% in IMPaCT, meaning that our higher rates of cardiometabolic risk are not a result of illness severity (Meyer et al. 2005).”

• cites Meyer et al. 2005Not checked yet

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Classified as probably not a substantial claim.

Exercise is linked to greater longevity in the general population.

“As exercise is linked to greater longevity in the general population (Paffenbarger et al. 1993; Manson et al. 2002), it is likely that greater emphasis on engaging in physical activity among those with severe mental illnesses (SMI) would help reduce mortality risk (Vancampfort et al. 2010).”

• cites Paffenbarger et al. 1993Not checked yet

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• cites Manson et al. 2002Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Patients with schizophrenia treated with clozapine have the least reduction in life expectancy of all patients with schizophrenia.

“This lack of difference is especially interesting in light of the evidence that patients with schizophrenia treated with clozapine have the least reduction in life expectancy of all patients with schizophrenia (Tiihonen et al. 2009; Hayes et al. 2014).”

• cites Tiihonen et al. 2009Not checked yet

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• cites Hayes et al. 2014Not checked yet

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May combine two claims.

Of the study population, 50% had evidence of glucose dysregulation, including 20% of the sample with type 2 diabetes, which is much higher than the rate in the general UK population.

“Of the study population, 50% had evidence of glucose dysregulation, including 20% of the sample with type 2 diabetes, which is much higher than the rate in the general UK population (International Diabetes Federation, 2013).”

• cites International Diabetes Federation, 2013Not checked yet

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May combine two claims.

In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.

“In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.”

• AssumptionRests on an assumption: The sample of 450 randomly selected out-patients with established psychosis from community mental health teams in England is representative of people with psychotic illnesses in the UK.

May combine two claims.

Strengths of this study include a sample of randomly selected individuals with psychosis from diverse ethnic backgrounds and the mix of urban and rural locations, adding to the generalizability of the study findings.

“Strengths of this study include a sample of randomly selected individuals with psychosis from diverse ethnic backgrounds and the mix of urban and rural locations adding to the generalizability of the study findings.”

May combine two claims.

This cohort of individuals with established psychosis had a high prevalence of both individual cardiometabolic risk factors and of the MetS.

“This cohort of individuals with established psychosis had a high prevalence of both individual cardiometabolic risk factors and of the MetS.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Dibenzodiazepines are associated with early emergence of cardiometabolic risk factors.

“A high proportion of this sample was prescribed dibenzodiazepines, which are associated with early emergence of cardiometabolic risk factors (Howes et al. 2004; Nielsen et al. 2010).”

• cites Howes et al. 2004Not checked yet

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• cites Nielsen et al. 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a recent 11-year follow-up of 517 people with schizophrenia, the overall standardized mortality ratio was 2.80, and smoking was a very strong predictor of death (relative risk 4.66).

“A recent 11-year follow-up of 517 people with schizophrenia showed an overall standardized mortality ratio of 2.80, smoking being a very strong predictor of death (relative risk of 4.66) (Dickerson et al. 2014).”

• cites Dickerson et al. 2014Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Findings from a systematic review have demonstrated that people with schizophrenia want to stop smoking and that it is possible to help them to do so.

“However, findings from a systematic review have demonstrated that people with schizophrenia want to stop smoking and that it is possible to help them to do so (Banham & Gilbody, 2010)”

• cites Banham & Gilbody, 2010Not checked yet

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Classified as probably not a substantial claim.

Greater emphasis on engaging in physical activity among those with severe mental illnesses would likely help reduce mortality risk.

“As exercise is linked to greater longevity in the general population (Paffenbarger et al. 1993; Manson et al. 2002), it is likely that greater emphasis on engaging in physical activity among those with severe mental illnesses (SMI) would help reduce mortality risk (Vancampfort et al. 2010).”

• cites Vancampfort et al. 2010Not checked yet

  Not checked in the free run.

May combine two claims.

In a large Australian prevalence survey in psychosis, rates of abdominal obesity greater than 80% were found, as well as comparable rates of MetS, dyslipidaemia and hypertension.

“Similar rates of cardiometabolic risk to what we found have been identified in a large Australian prevalence survey in psychosis, where rates of abdominal obesity greater than 80% were found, as well as comparable rates of the MetS, dyslipidaemia and hypertension (Galletly et al. 2012).”

• cites Galletly et al. 2012Not checked yet

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May combine two claims.

Limitations of the study include the cross-sectional design and the lack of a control group.

“Limitations of the study include the cross-sectional design, and the lack of a control group.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Smoking complicates treatment because hydrocarbons in cigarette smoke accelerate the metabolism of dibenzodiazepines, clozapine and olanzapine.

“Smoking not only increases the risk of early death, but also complicates treatment, in that the hydrocarbons in cigarette smoke accelerate the metabolism of dibenzodiazepines, clozapine and olanzapine (Rostami-Hodjegan et al. 2004).”

• cites Rostami-Hodjegan et al. 2004Not checked yet

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May combine two claims.

The prevalence of MetS in this UK sample of people with established psychosis (56.8%) greatly exceeds the international figure of 34% from a recent meta-analysis of MetS in schizophrenia.

“Of our participants, 56.8% met criteria for the MetS, greatly exceeding the international figure of 34% described in a recent meta-analysis of the MetS in schizophrenia (Mitchell et al. 2013).”

• cites Mitchell et al. 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Practice in in-patient psychiatric services has improved with the advent of incentivization and of shared guidelines for CVD risk management in psychosis such as the Lester Cardiometabolic Health Resource.

“Practice in in-patient psychiatric services has improved with the advent of incentivization and of shared guidelines for CVD risk management in psychosis such as the Lester Cardiometabolic Health Resource (Lester et al. 2014).”

• cites Lester et al. 2014Not checked yet

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Classified as probably not a substantial claim. May combine two claims.

Our study population, compared with this primary care-only population, may be functionally or symptomatically more impaired, and antipsychotic prescribing patterns may be different.

“Our study population, compared with this primary care-only population, may be functionally or symptomatically more impaired; and antipsychotic prescribing patterns may be different – for instance, clozapine is rarely prescribed in primary care.”

May combine two claims.

We have no data on duration of antipsychotic treatment and previous antipsychotic treatments used over the longitudinal course of an individual's illness, both of which are confounding factors that could potentially make an impact on an individual's cardiometabolic risk factors.

“We have no data on duration of antipsychotic treatment and previous antipsychotic treatments used over the longitudinal course of an individual's illness, both of which are confounding factors that could potentially make an impact on an individual's cardiometabolic risk factors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Central obesity is known to be the best predictor of morbidity and mortality.

“Although central obesity is known to be the best predictor of morbidity and mortality (Zimmet et al. 2001), waist circumference has not to date been routinely measured in people with psychosis, although it has now been included in the latest National Institute of Health and Clinical Excellence (2014) guidelines for schizophrenia.”

• cites Zimmet et al. 2001Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

We have not adjusted for the effect of socio-economic deprivation.

“We have not adjusted for the effect of socio-economic deprivation.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A recent Scottish paper noted an excess of mortality in SMI linked to deprivation, although this effect was not evident for deaths due to cerebrovascular disease or CVD.

“A recent Scottish paper noted an excess of mortality in SMI linked to deprivation, although this effect was not evident for deaths due to cerebrovascular disease or CVD (Langan Martin et al. 2014).”

• cites Langan Martin et al. 2014Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Missing data from metabolic measures and clinical assessment scales may have introduced a selection bias into the study.

“The missing data from metabolic measures and clinical assessment scales may have introduced a selection bias into the study, but it is not obvious what effect such a bias would result in.”