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Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial
Open accessAbstract
Background: The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment. Method: Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18–65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria. Results: High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ≥ 30 kg/m 2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS. Conclusions: 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.
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TL;DR
In baseline data from the IMPaCT RCT of 450 UK outpatients with established psychotic illness, cardiometabolic risk factors were highly prevalent, with 56.8% of those with complete measures meeting IDF criteria for metabolic syndrome. Central obesity, obesity, diabetes/glucose dysregulation, hypertension, dyslipidaemia, and smoking were common and exceeded general-population comparisons.
Key findings
- Of 308 patients with complete measures, IDF metabolic syndrome prevalence was 56.8% (175/308); ATP-III prevalence was 56.2% (173/308). Central obesity was present in 83% overall, including 95% of women (160/169) versus 74% of men (167/227).
- Obesity (BMI ≥30 kg/m²) was 50% (192/398), and women were more likely to be obese than men (61% v. 42%, p < 0.001). Type 2 diabetes criteria were met by 20% (66/330), with an additional 30% showing glucose dysregulation; hypertension was 54% (214/398), dyslipidaemia 89% (305/342), and smoking 62% (268/432).
- High-intensity physical activity was reported by 12% (54) and was associated with lower metabolic syndrome rates (15/41 v. 160/267, p = 0.004). PANSS scores were not significantly associated with individual cardiometabolic risk factors, while greater functional impairment on GAF was associated with obesity, diabetes, and hypertension, and higher MADRS scores with obesity.
- White patients had higher IDF metabolic syndrome rates than black African or Caribbean patients (114/171 v. 47/101, p = 0.001); there was no gender difference in metabolic syndrome, no duration-of-illness effect, and no excess risk with clozapine or olanzapine.
Methods
- Baseline cross-sectional analysis within the IMPaCT randomized controlled trial; 450 randomly selected outpatients aged 18–65 with established psychotic illness were recruited from community mental health teams in five Mental Health NHS Trusts across urban and rural England.
- Data included sociodemographic and clinical measures, PANSS, GAF, MADRS, AUDIT, smoking/cannabis/urine drug screen, DINE, and IPAQ; physical measures included height, weight, blood pressure, waist circumference, and fasting blood samples. Metabolic syndrome was defined using IDF and NCEP ATP-III criteria.
- Analyses used descriptive statistics, Student’s t tests for parametric data, and χ² tests for categorical variables; tests were two-sided with p ≤ 0.05 considered significant.
Limitations
- Stated: cross-sectional design, no control group, no adjustment for socioeconomic deprivation; missing metabolic and clinical data may have introduced selection bias; duration of illness was self-reported; no data on duration or previous antipsychotic treatment; first-episode psychosis and primary care-only patients were excluded.
- Stated: recruitment was England-wide but predominantly from Greater London, and findings may not generalize to patients with these diagnoses managed only in primary care.
- Evident: baseline cross-sectional data cannot establish causality or temporal ordering; metabolic syndrome prevalence is based on 308/450 participants with complete measures, so complete-case analysis may affect representativeness.
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58 Own result · 47 Not checked yet · 13 Own method · 7 Own interpretation
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“White patients had higher serum triglycerides than black African or Caribbean patients (mean difference = 0.89, p < 0.003).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Ethnicity
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Those with IDF MetS were older (mean age = 44.68 years, s.d. = 9.8) than those without IDF MetS (42.12 years, s.d. = 10.4) (t = −2.28, p = 0.028).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > MetS
plaincorrelationaln = 308 ·- Asserted: passes — The authors put it forward as true.
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In the paper
“Of the 13 individuals who were not prescribed antipsychotics and who had complete measures to allow for MetS status to be confirmed, eight met the criteria for IDF MetS.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > MetS
plainn = 13- Asserted: passes — The authors put it forward as true.
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In the paper
“In this group, the prevalence of IDF MetS was 56.8% (n = 175/308).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > MetS
plainn = 175- Asserted: passes — The authors put it forward as true.
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In the paper
“Female patients had significantly higher BMIs than males [t = 2.329, degrees of freedom (df) = 426, p < 0.020].”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Of the subjects, 48% (192/398) were obese (BMI > 30 kg/m2).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Also, there was no excess of other cardiometabolic risk factors [dyslipidaemia (p = 0.418), hypertension (p = 0.546) and diabetes (p = 0.463)].”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The prevalence of the MetS as defined by the ATP-III criteria was 56.2% (n = 173/308).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > MetS
plainn = 173- Asserted: passes — The authors put it forward as true.
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In the paper
“A consistent relationship was found between cardiometabolic risk factors and functional impairment as measured by GAF scores.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Psychopathology and cardiometabolic risk factors (see Table 4)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The prescription of either olanzapine or clozapine (n = 191) (which are the antipsychotic medications traditionally associated with the highest risk of metabolic dysfunction) was not associated with an increased rate of obesity (n = 80, 42%) compared with those not prescribed either dibenzodiazepine (n = 113, 54%) (χ2 = 1.270, df = 1, p = 0.153).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
plainn = 191- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 37
- Probably not a substantial claim. 44
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In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Ethnicity
plain- Asserted: passes — The authors put it forward as true.
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“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results
plainn = 450- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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In the paper
“Hypertension was present in 214/398 (54%), of whom 62 were on anti-hypertensive therapy.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Psychopathology and cardiometabolic risk factors (see Table 4)
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results
plainn = 449- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results
plainn = 257- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Of the participants, 30% (n = 127) were prescribed clozapine and 16% (n = 70) olanzapine.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results
plainn = 127- Asserted: passes — The authors put it forward as true.
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In the paper
“There was no significant difference between mean BMI (p = 0.241) and waist circumference (p = 0.437) when stratified by geographical location (by borough).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results
plainn = 321- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Study design
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > MetS
plainn = 308- Asserted: passes — The authors put it forward as true.
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In the paper
“Of the subjects, 62% (268/432) smoked tobacco, smoking an average of 18.2 (s.d. = 11.6) cigarettes per day.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Lifestyle measures
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Drug and alcohol use
plainn = 68- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Drug and alcohol use
plainn = 13- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Lifestyle measures
plainn = 196- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Lifestyle measures
plainn = 210- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Drug and alcohol use
plainn = 76- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Walker et al. 2015
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Mitchell et al. 2013
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“On meta-analysis, a third of patients with schizophrenia have the MetS, with this proportion increasing with duration of illness (Mitchell et al. 2013).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Mitchell et al. 2013
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Arango et al. 2011
plaincorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Vancampfort et al. 2013a
- Not checked yetcites Basu et al. 2004
- Not checked yetcites Bobes et al. 2012
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Hanley et al. 2005
- Not checked yetcites De Hert et al. 2011
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Hanley et al. 2005
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Saha et al. 2007
- Not checked yetcites Kilbourne et al. 2009
- Not checked yetcites Brown et al. 2010
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Vancampfort et al. 2013b
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Encouragingly, various UK medical Royal colleges have recently agreed joint management strategies for CVD risk in psychotic illnesses (Lester et al. 2014).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Lester et al. 2014
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Clinical and sociodemographic variables
What the sources say
- Not checked yetcites Kay et al. 1989 source
- Not checked yetcites American Psychiatric Association, 2002
- Not checked yetcites Montgomery & Åsberg, 1979
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Alvarez-Jimenez et al. 2010
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data for all measures were collected through face-to-face interviews conducted by trained research assistants.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Clinical and sociodemographic variables
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The Dietary Instrument for Nutrition Education (DINE; Roe et al. 1994) was used to assess the dietary patterns of participants over the past week.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Cardiometabolic risk factors
What the sources say
- Not checked yetcites Roe et al. 1994
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Study design
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Morgan et al. 2014
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“As both serum glucose and triglycerides are affected by recent food ingestion, we took fasting blood samples.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Cardiometabolic risk factors
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Height, weight and blood pressure (BP) were measured using standardized techniques.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Cardiometabolic risk factors
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Cardiometabolic risk factors
What the sources say
- Not checked yetcites Craig et al. 2003
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Clinical and sociodemographic variables
What the sources say
- Not checked yetcites Saunders et al. 1993
- Not checked yetcites Fagerstrom, 1978
- Not checked yetcites Fagerstrom & Schneider, 1989
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Waist circumference was measured at the umbilicus with the patient standing.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Cardiometabolic risk factors
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The BP values presented are the second BP measurements, taken after an interval of 5 min.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Cardiometabolic risk factors
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Method > Study design
What the sources say
- Not checked yetcites Gaughran et al. 2013
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Lester et al. 2014
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Introduction
What the sources say
- Not checked yetcites Schizophrenia Commission, 2012
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“This meta-analysis found a lack of homogeneity in the distribution of MetS prevalence across individual studies.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Mitchell et al. 2013
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Meyer et al. 2005
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Paffenbarger et al. 1993
- Not checked yetcites Manson et al. 2002
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Tiihonen et al. 2009
- Not checked yetcites Hayes et al. 2014
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites International Diabetes Federation, 2013
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Abstract > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This cohort of individuals with established psychosis had a high prevalence of both individual cardiometabolic risk factors and of the MetS.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Howes et al. 2004
- Not checked yetcites Nielsen et al. 2010
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Dickerson et al. 2014
boostedcorrelationaln = 517- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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)”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Banham & Gilbody, 2010
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Vancampfort et al. 2010
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Galletly et al. 2012
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Limitations of the study include the cross-sectional design, and the lack of a control group.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Rostami-Hodjegan et al. 2004
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Mitchell et al. 2013
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Conclusion
What the sources say
- Not checked yetcites Lester et al. 2014
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Conclusion
What the sources say
- Not checked yetcites Zimmet et al. 2001
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We have not adjusted for the effect of socio-economic deprivation.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
What the sources say
- Not checked yetcites Langan Martin et al. 2014
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
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.
“A total of 450 randomly selected out-patients, aged 18–65 years, with an established psychotic illness were recruited.”
The paper relies on this without support.
Diagnoses extracted from clinical notes accurately reflect ICD-10 criteria for psychotic illness.
“Diagnoses were based on ICD-10 diagnostic criteria and were extracted from the documented diagnosis in the clinical notes at the time of recruitment.”
The paper relies on this without support.
Waist circumference has not to date been routinely measured in people with psychosis.
“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.”
The paper relies on this without support.
First-episode psychosis (FEP) patients have different cardiovascular disease (CVD) profiles in the early stages of psychosis.
“The exclusion of FEP patients from this study recognizes the different CVD profiles in the early stages of psychosis.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“This finding warrants further investigation, but may be related to a greater propensity to obesity and central obesity in women with SMI compared to men 32 , since central obesity is a significant risk factor for hyperglycaemia.”
From Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis (2016) · cites this paper as [32]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“Fasting glucose, mmol/l (≥5.6 mmol/l) | 322 | 31 (27.7–38.4)”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“5.9 (2.3)/44 | 6.0 (3.3)/35”
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Lifestyle measures
“lower rates of the MetS were found in those with high-intensity physical activity (n = 15/41), compared with those engaging in low-intensity physical activity (n = 160/267)”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Lifestyle measures
“44% (n = 196) were engaging in low-intensity physical activity”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Of the respondents, 28% (n = 68/291) had hazardous/harmful alcohol use (AUDIT score ≥ 8)”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Drug and alcohol use
Reported 28 · recomputed 23.367698
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“Female patients had significantly higher BMIs than males [t = 2.329, degrees of freedom (df) = 426, p < 0.020].”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“Body mass index, kg/m2 (> 30 kg/m2) | 398”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“LDL-cholesterol, mmol/l (≥3.0 mmol/l) | 303 | 51 (45.2–56.4) | 3.0 (0.1) (0.3–6.3)”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“3.0 (1.0)/50 | 3.1 (1.0)/52”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“Of the subjects, 48% (192/398) were obese (BMI > 30 kg/m2).”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Cardiovascular risk factors (see Table 3)
“Body mass index, kg/m2 (> 30 kg/m2) | 398 | 50 (44–55)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Discussion
“we did find associations between increased functional impairment and obesity, diabetes and hypertension”
§ Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial > Results > Psychopathology and cardiometabolic risk factors (see Table 4)
“56.7 (12.7) | 1.653/0.099”
Citations
Cites
International physical activity questionnaire: 12-country reliability and validity
CRAIG, C. L., MARSHALL, A. L., SJ??STR??M, M., BAUMAN, A. E., BOOTH, M. L., AINSWORTH, B. E., PRATT, M., EKELUND, U., YNGVE, A., SALLIS, J. F., et al. (2003) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000078924.61453.fb · Cited by 21,619 · cited 1×
“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).”
MethodA new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962 · cited 1×
“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).”
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“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.”
MethodGrundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., Gordon, D. J., Krauss, R. M., Savage, P. J., Smith, S. C., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.169404 · Cited by 11,961 · cited 1×
“Additionally, we also determined if each patient met the adapted National Cholesterol Education Program (NCEP) Third Adult Treatment Panel (ATP-III) criteria (NCEP ATP-III criteria) (Grundy et al. 2005), to allow for comparison with selected studies.”
MethodSelf-citationThe metabolic syndrome—a new worldwide definition
Alberti, K. G. M., Zimmet, P., & Shaw, J. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67402-8 · Cited by 9,352 · cited 2×
“The IDF definitions of other cardiometabolic risk factors and of the MetS were used (see Table 1) (Alberti et al. 2005, 2006).”
BackgroundMethodAlberti, K. G. M. M., Zimmet, P., & Shaw, J. (2006) · Diabetic Medicine · doi:10.1111/j.1464-5491.2006.01858.x · Cited by 6,597 · cited 1×
“The IDF definitions of other cardiometabolic risk factors and of the MetS were used (see Table 1) (Alberti et al. 2005, 2006).”
MethodGlobal and societal implications of the diabetes epidemic
Zimmet, P., Alberti, K. G. M. M., & Shaw, J. (2001) · Nature · doi:10.1038/414782a · Cited by 5,883 · cited 2×
“Although central obesity is known tobe thebest predictorofmorbidityandmortality (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 schizoph…”
BackgroundSobell, L. C., & Sobell, M. B. (1992) · Measuring Alcohol Consumption · doi:10.1007/978-1-4612-0357-5_3 · Cited by 4,110 · cited 3×
“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.”
MethodInternational Expert Committee report on the role of the A1c assay in the diagnosis of diabetes
The International Expert Committee (2009) · Diabetes Care · doi:10.2337/dc09-9033 · Cited by 3,185
Walker, E. R., McGee, R. E., & Druss, B. G. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.2502 · Cited by 2,976 · cited 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).”
BackgroundInfluential
Research works printed but not linked: 8
- 2012, The Abandoned Illness: A Report by the Schizophrenia Commission
- 2014, National Institute of Health and Clinical Excellence: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care
- 2013, IDF Diabetes Atlas
- 2013, Statistics on Smoking: England, 2013
- 2002, Diagnostic and Statistical Manual of Mental Disorders
- Craig, 2011, Health Survey for England 2010
- 2012, Report of the National Audit of Schizophrenia
- Lester, 2014, Positive Cardiometabolic Health Resource: an Intervention Framework for Patients with Psychosis on Antipsychotic Medication
Cited by
Sorted by citations
Items 101–141 of 141
Zeleke, T. M., Endale, F., Tesfaye, T. S., Munea, A. L., & Kumsa, F. A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0320119 · Cited by 4
“Studies indicate a high prevalence of dyslipidemia among adults with coexisting chronic diseases such as mental disorders [4], hypertension, diabetes mellitus, metabolic syndrome, and HIV (human immunodeficiency virus) patients [5].”
Kwak, Y. B., & Kim, J. Y. (2022) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.21222 · Cited by 4
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Clinical characteristics of familial schizophrenia
Liu, N., Zhou, H. J., Xiong, X., Li, Q., Jiang, X., Zhao, J., Yang, X., Zhang, M., Wang, X., Wang, G., et al. (2020) · Asia-Pacific Psychiatry · doi:10.1111/appy.12422 · Cited by 4
“Mounting evidence has shown that patients with schizophrenia are also at an increased risk of chronic somatic comorbidities, such as metabolic syndromes, diabetes, and respiratory disease (De Hert et al., 2011; Gardner-Sood et al., 2015).”
BackgroundPerez, C. S. D. H., Ciufolini, S., Gardner-Sood, P., Krivoy, A., Young, A. H., Murray, R. M., Ismail, K., Atakan, Z., Greenwood, K., Smith, S. M., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.038 · Cited by 4
Self-citationIs Schizophrenia a Disorder of Accelerated Whole-System Aging?
Kochunov, P., & Hong, L. E. (2024) · Biological Psychiatry · doi:10.1016/j.biopsych.2024.03.013 · Cited by 4
“…that even young adult – to-middle-aged people with schizophrenia have a 1.5 to 3 times higher rate of chronic metabolic and cardio-vascular illnesses for whom the older age is the main risk factor (6), and nearly 60% of young adults with psychosis meet the criteria for metabolic syndrome (7).”
BackgroundInfluentialPoole-Wright, K., Gaughran, F., Murray, R. M., & Chalder, T. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.06.032 · Cited by 3
Self-citationShrestha, N., Parker, A. G., Jurakić, D., Biddle, S., & Pedišić, Ž. (2021) · Issues in Mental Health Nursing · doi:10.1080/01612840.2021.1972189 · Cited by 3
“People with mental illness have an increased risk of chronic diseases and shorter life expectancy compared to the general population (Gardner-Sood et al., 2015; Ribe et al., 2014; Vancampfort et al., 2015).”
BackgroundOkuma, A., Nakajima, M., Sonoo, T., Nakamura, K., & Goto, T. (2023) · Acute Medicine & Surgery · doi:10.1002/ams2.814 · Cited by 3
Major psychiatric disorders and the aetiology and progression of coronary heart disease
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Association between Metabolic Syndrome and Substance Dependence: A Cross-Sectional Study in Kenya
Mbugua, S. M., Mecha, E. O., Kirira, P., Njoroge, M., Malala, B., Gitaka, J., Makokha, F., & Mwenda, C. S. (2022) · European Journal of Medical and Health Sciences · doi:10.24018/ejmed.2022.4.3.1030 · Cited by 2
Factor structure of psychosis screening questionnaire in Ugandan adults
Kwagala, C., Ametaj, A., Kim, H. H., Kyebuzibwa, J., Rogers, O., Stevenson, A., Gelaye, B., & Akena, D. H. (2024) · BMC Psychiatry · doi:10.1186/s12888-023-05485-2 · Cited by 2
“Moreover, studies have demonstrated that people with psychotic disorders have an increased risk of cardiovascular disease [2], metabolic syndrome [3] and diabetes mellitus [4], which all predict premature mortality and can negatively impact quality of life [5].”
BackgroundPatel, D., Msosa, Y. J., Wang, T., Williams, J., Mustafa, O. G., Gee, S., Arroyo, B., Larkin, D., Tiedt, T., Roberts, A., et al. (2024) · JMIR Research Protocols · doi:10.2196/49548 · Cited by 2
“Recorded rates of diabetes among ethnically diverse middle-aged people with a diagnosis of established psychosis in South London reach 20%, with a further 30% evidencing raised blood sugar levels (dysglycemia) [7].”
Self-citationBeyene, M. G., Teferra, S., & Fenta, T. G. (2024) · Cureus · doi:10.7759/cureus.69065 · Cited by 4
Physical effort exertion and pain: Links with trait-based risk for psychopathology
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Broderick, J. M., Vancampfort, D., Mockler, D., Bennett, K., Waugh, A., McDonough, C., Cramer, H., & Walshe, M. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013213 · Cited by 2
Recording of cardiovascular risk factors by general practitioners in patients with schizophrenia
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Molist, N. R. I., Tauste, M. A., Poch, P. R., Gallent, M. G., Santos, J. M., Serra, M., Frau-Rosselló, N., Gallego-Peña, E., & Boreu, Q. F. (2023) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000743 · Cited by 2
Alhawari, H. H., Al-Khatib, S., Alshelleh, S. A., Ribie, M., Owies, F. A., Harb, M., Alhabahbeh, R., & Toubasi, A. A. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e40440 · Cited by 1
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“49 People with mental illness have a significantly higher risk of obesity than those without mental illness.(50) The prevalence of obesity, defined as a BMI of ≥ 30 kg/m(2), was 23.”
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Mental disorders and physical activity: Epidemiological analyses using Australian datasets
Suetani, S. (2019) · The University of Queensland · doi:10.14264/uql.2019.592 · Cited by 1
Construct Validity of the Psychosis Screening Questionnaire in Ugandan AdultsPreprint
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“Moreover, studies have demonstrated that people with psychotic disorders have an increased risk of cardiovascular disease [2], metabolic syndrome [3] and diabetes mellitus [4], which all predict premature mortality and can negatively impact quality of life [5].”
BackgroundPhysical health assessment in forensic settings: A dual diagnosis case study
Hands, F., Goddard, K., & Pegram, A. M. (2016) · British Journal of Mental Health Nursing · doi:10.12968/bjmh.2016.5.5.221
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“People who suffer from psychiatric disorders live 15-25 years less than the general population, mostly due to the heightened mortality rate from cardiovascular diseases [2].”
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Cardiovascular Risk and Metabolic Syndrome in Individuals with Mental Disorders
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Early-life stress and inflammatory cytokines in psychoses: from bench to community-based research
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Benefits, Assessment, and Preferences of Physical Activity in Psychosis
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Stroud, R. E., Hook, K., Kebede, M. A., Atwoli, L., Baker, M., Chibnik, L. B., Gelaye, B., Gichuru, S., Kariuki, S. M., Koenen, K. C., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0356360
Metadata
- Authors
- Gardner-Sood, P., Lally, J., Smith, S., Atakan, Z., Ismail, K., Greenwood, K. E., Keen, A., O'Brien, C., Onagbesan, O., Fung, C., Papanastasiou, E., Eberherd, J., Patel, A., Ohlsen, R., Stahl, D., David, A., Hopkins, D., Murray, R. M., Gaughran, F., & on behalf of the IMPaCT team
- Affiliations
- King's College London (GB)
- National Health Service (GB)
- University of Sussex (GB)
- Corresponding author
- Gaughran, F.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-05-12
- Volume
- 45
- Issue
- 12
- Pages
- 2619-2629
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4531468
- OpenAlex
- W2166495311
- Semantic Scholar
- 487ef347e280ef3e816147fd31590df2a7dd7e33
- Cited by
- 140
- References
- 64
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 10 · 2023: 10 · 2022: 12 · 2021: 17 · 2020: 13 · 2019: 13 · 2018: 21 · 2017: 15 · 2016: 18 · 2015: 3
- FWCI
- 15.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Lund University Publications (Lund University) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (0606-1049, RP-PG-0606-1049, PG-0606-1049)
- King's College London
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- metabolic syndrome, psychosis, cardiometabolic risk factors, obesity, abdominal obesity, type 2 diabetes, waist circumference, sex differences, disease severity, functional disability, lifestyle habits, IMPACT trial
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Benzodiazepines, Cardiovascular Diseases, Community Mental Health Centers, Diabetes Mellitus, Type 2, England, Female, Humans, Male, Middle Aged, Obesity, Risk Factors, Rural Population, State Medicine, Urban Population, Prevalence, Sex Distribution, Metabolic Syndrome, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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