Metabolic Syndrome and Oxidative Stress in Ghanaian Psychiatric Patients: Conventional Vs. Atypical Antipsychotic Medications

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Metabolic syndrome (MetS), a major public health problem linked to cardiovascular and other morbidities, has gained a significant importance in clinical settings and patients with severe mental illnesses who are at higher risk for different components of this syndrome due to their illness and its treatment require careful and regular monitoring in this regard. Even though MetS has been found to be more prevalent among psychiatric patients than among any other population group, no data exist on its prevalence in Ghanaian psychiatric patients. This study seeks to find the prevalence of the MetS, its individual components and oxidative stress in psychiatric patients on antipsychotics (conventional and atypical) compared to newly diagnosed psychiatric patients. This cross-sectional study of patients attending psychiatric department of the Komfo Anokye Teaching Hospital (KATH) between February 2009 and July 2010. A total of 200 psychiatric patients comprising 100 newly diagnosed antipsychotic naïve patients and 100 patients on antipsychotic medication were sampled for the study. Prevalence of MetS diagnosed using the World Health Organization (WHO), International Diabetes Federation (IDF) and the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) criteria for defining MetS was employed. The overall prevalence of MetS was 11.5%, 13.5% and 15.5% using NCEP ATP III, WHO and IDF criteria respectively. The prevalence was significantly higher among psychiatric patients on treatment as compared to treatment naïve group using NCEP ATP III (21.0% vs. 2.0%; p < 0.0001) and IDF (29.0% vs. 2.0%; p < 0.0001) criteria but not WHO (13.0% vs. 14.0%; p = 0.8372). Irrespective of the criteria used, the prevalence of MetS was higher among patients on atypical vs. typical antipsychotic medication (i.e. 44.4% vs. 18.7% for NCEP ATP III; 22.2% vs. 12.1% for WHO and 56.6% vs. 27.5% for IDF), however, these differences did not reach a significant level. Oxidative stress appears to confer some sort of protection against the development of MetS as defined by the IDF criteria among these subjects. Prevalence of MetS in this population was double that in the general Ghanaian population. Prevalence of MetS was not only highly prevalent among Ghanaian patients treated with antipsychotic drugs, it was also higher among patients on atypical vs. conventional antipsychotic medication. Regular monitoring of metabolic parameters should be considered as a standard part of their medical care.
A Thesis Submitted in Fulfillment of the Requirements for the Degree of Master of Philosophy in the Department of Molecular Medicine, School of Medical Sciences, 2010.