Cited by 141Schizophrenia research and treatmentDiabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, Diet

The DOI matches its Crossref record; 63 of the 64 references it cites were found in a registry or an index; none of the 62 sources its claims cite is checked for support yet.

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

Open access

Abstract

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.

Overview

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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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Integrity signals

Registry

Crossref · 10.1017/s0033291715000562

Cites

63 of 63 references verified0 citation errors · 0 not checkable

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Claims the paper makes

58 Own result · 47 Not checked yet · 13 Own method · 7 Own interpretation

Verify all 62 references — free account
  • It may state two separate claims as one. 37
  • Probably not a substantial claim. 44
66 of 66
  • 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.”
4 of 4

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Citations

Cites

Show all 64 references

Research works printed but not linked: 8

  1. 2012, The Abandoned Illness: A Report by the Schizophrenia Commission
  2. 2014, National Institute of Health and Clinical Excellence: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care
  3. 2013, IDF Diabetes Atlas
  4. 2013, Statistics on Smoking: England, 2013
  5. 2002, Diagnostic and Statistical Manual of Mental Disorders
  6. Craig, 2011, Health Survey for England 2010
  7. 2012, Report of the National Audit of Schizophrenia
  8. Lester, 2014, Positive Cardiometabolic Health Resource: an Intervention Framework for Patients with Psychosis on Antipsychotic Medication

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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.
Venue
Psychological Medicine
Published
2015-05-12
Volume
45
Issue
12
Pages
2619-2629
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
OpenAlex
W2166495311
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
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

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