Metabolic Syndrome among Schizophrenic Patients: A Comparative Cross-Sectional Study in the Middle Belt of Ghana

Hindawi Schizophrenia Research and Treatment Volume 2018, Article ID 6542983, 9 pages https://doi.org/10.1155/2018/6542983 Research Article Metabolic Syndrome among Schizophrenic Patients: A Comparative Cross-Sectional Study in the Middle Belt of Ghana Angela Owusu–Ansah,1 Anto Berko Panyin,1 Christian Obirikorang ,2 Christian Agyare ,3 Emmanuel Acheampong ,2,4 Simon Kwofie,2 Enoch Odame Anto ,2,4 and Emmanuella Nsenbah Batu2 1 Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana 2 Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana 3 Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana 4 School of Medical and Health Sciences, Edith Cowan University, WA, Australia Correspondence should be addressed to Emmanuel Acheampong; Received 6 February 2018; Revised 28 May 2018; Accepted 13 June 2018; Published 28 June 2018 Academic Editor: Hugo Schnack Copyright © 2018 Angela Owusu–Ansah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The study determined the prevalence of MetS in patients with schizophrenia at the Psychiatric Unit of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. This comparative cross-sectional study recruited 348 schizophrenic patients comprising 236 antipsychotic-treated and 112 newly diagnosed treatment-naı̈ve patients. The MetS prevalence was assessed based on World Health Organization (WHO), International Diabetes Federation (IDF), and the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) criteria. The overall prevalence of MetS was 14.1%, 20.4%, and 23.6% using NCEP ATP III, WHO, and IDF criteria, respectively, compared to 7.8%, 3.9%, and 2.2% reported in the general Ghanaian population. The prevalence was significantly higher among treated psychiatric patients compared to treatment-naı̈ve group based on NCEP ATP III (17.8% versus 6.2%; p = 0.0001), WHO (26.2% versus 8.0%; p < 0.0001), and IDF (30.3% versus 10.0%; p < 0.0001). MetS was prevalent among patients on atypical antipsychotics compared to typical antipsychotics irrespective of the criteria used (i.e., 17.1% versus 11.1% for NCEP ATP III; 29.5% versus 25.9% for WHO; and 44.3% versus 18.5% for IDF). Using logistic regression model, obesity, raised fasting blood sugar, raised total cholesterol, and decreased high density lipoprotein were observed to be significant predictors of MetS (p<0.05).The study found high prevalence of MetS in Ghanaians with schizophrenia and higher prevalence rate of MetS associated with monotherapy. Regular monitoring of cardiometabolic parameters should be an important therapeutic objective in the management of these patients. 1. Introduction Schizophrenia is a chronic mental disorder which involves disturbances of thought, perception, affect, and social behavior [1]. It is ranked among the top ten causes of disability worldwide with mortality rates two times as high as in the general population [2–4]. Although accidents and suicide account for just a portion of this high mortality rate, more than two-thirds of the rate is caused by different forms of comorbid physical diseases such as cardiovascular and metabolic syndrome [3]. The emergence of these physical diseases has been linked to poor lifestyle (smoking, sedentary lifestyle, and poor diet) and cardiovascular risk factors [5]. Metabolic syndrome (MetS) is a group of disorders which includes central obesity, dyslipidemia, hypertension, 2 abnormal glucose homeostasis, proinflammatory state, and prothrombotic state [6, 7]. The prevalence of MetS seems to be common and rising in the general population possibly due to high intake of calories and a lifestyle of inactivity, irrespective of definition criteria [8, 9]. It is, however, worth considering that some population groups and, for that matter, particular patient groups even have an increased propensity of developing MetS. Several studies have convincingly indicated that schizophrenic patients are twice at risk of developing MetS compared to the general population [8, 10, 11]. Before the introduction of antipsychotics, there were increasing reports of glucose dysregulations (i.e., glucose intolerance, insulin resistance, and hyperglycaemia) by researchers in schizophrenic patients [12]. Moreover, several recent studies have reported increased prevalence of hyperglycaemia, insulin resistance, and impaired fasting glucose tolerance in first episode, antipsychotic-naı̈ve schizophrenic patients compared to healthy control subjects [11]. Consequently, treatment with antipsychotics in people with schizophrenia tends to worsen or even exacerbate these MetS and, thus, contribute to the increased prevalence from 40% to 60% versus 30% in the general population [13, 14]. The atypical antipsychotics are generally known to possess greater propensity of causing these metabolic abnormalities than the typical antipsychotics. Concerning the metabolic dysregulation that accompanied treatment with antipsychotic medications, several studies have recommended a baseline and continuous monitoring (every 6 months) of fasting blood glucose, glycated haemoglobin, and fasting lipid profile to be done in routine clinical practice with all atypical antipsychotics [15–17]. However, in resource constraint health systems as we find in psychiatric hospitals in Ghana, such monitoring is not routinely undertaken, hence the difficulty in determining the prevalence of these metabolic dysregulations. There is a need for current data to serve as a basis for decision-making in terms of routine monitoring for metabolic dysregulations among these patients by healthcare providers in Ghana. Therefore, this study sought to determine the prevalence of MetS among patients with schizophrenia. 2. Methods 2.1. Study Design and Setting. This was a comparative crosssectional study which took place at the Out-Patient Department of the Psychiatry Unit of Komfo Anokye Teaching Hospital, (KATH) over a period of five (5) months (April to August 2016). KATH is a 1200-bed facility located in Kumasi in the Ashanti region of Ghana with a projected population of 4,780,380 according to the 2010 census, accounting for 19.4% of Ghana’s total population. The Ashanti region is centrally located in the middle belt of Ghana. It lies between longitudes 0.15W and 2.25W, and latitudes 5.50N and 7.46N. The region is divided into 27 districts. The Psychiatry Unit, which is a department under Internal Medicine Directorate, serves both in- and out-patients. About 150 schizophrenic patients are attended to every month on out-patient basis (...truncated)