Metabolic changes, inflammation and mortality in psychotic disorders

Jaakko Keinänen

Research output: ThesisDoctoral ThesisCollection of Articles


People with psychotic disorders have an increased risk of obesity, cardiovascular disease and diabetes. Together with a high risk for suicide, these lead to a reduction of the average lifespan by 15-20 years. Identifying clinical predictors of cardiovascular disease and mortality in psychotic disorders is important. This study examined anthropometric measures and lipid and glucose metabolism in people with first-episode psychosis (FEP). Predictors of weight gain and increased waist circumference were analysed. In addition, predictors of systemic low-grade inflammation as measured by high-sensitivity C-reactive protein (hs-CRP), an independent risk factor for cardiovascular disease and mortality, were examined. This study also investigated mortality and factors associated with mortality risk in non-affective psychosis (NAP) during a 13-year follow-up using data from the Health 2000 Study. People with FEP and healthy controls had similar body mass index, waist circumference, hs-CRP and fasting glucose at study baseline. The levels of total and low-density lipoprotein cholesterol, triglyceride, insulin and insulin resistance were increased in FEP as compared to controls already at baseline. Glucose and lipid parameters did not change significantly during the follow-up in FEP. However, marked weight gain (median 9.6 kg) and increase in waist circumference (6.0 cm) were observed during the first year of treatment. Insulin resistance and olanzapine medication at baseline predicted more weight gain during the follow-up. Insulin resistance also predicted increase in waist circumference. An over 2.5-fold increase in hs-CRP was observed during the follow-up in FEP, and the levels of hs-CRP were strongly related to waist circumference and female gender. The mortality risk in NAP was increased threefold, and remained increased over twofold when adjusted for known risk factors for mortality. Antipsychotic medication use was associated with lower natural-cause mortality risk, and smoking with increased risk. In line with previous studies, people with FEP had a significant increase in body weight and waist circumference during the first year of treatment of the psychotic disorder. Insulin resistance predicted weight gain and abdominal obesity, which is a novel and clinically important finding. Low-grade inflammation was strongly related to the increase in abdominal adiposity, suggesting that hs-CRP is primarily a marker of metabolic risk in people with FEP. Smoking cessation should be promoted to reduce the excess mortality in psychotic disorders. Improving detection and quality of treatment of physical diseases in people with psychotic disorders seems necessary to prevent premature mortality.
Original languageEnglish
  • Suvisaari, Jaana, Supervisor
  • Mantere, Outi, Supervisor
Award date30 Nov 2018
Place of PublicationHelsinki
Print ISBNs978-951-51-4566-6
Electronic ISBNs978-951-51-4567-3
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Psychotic Disorders
  • +epidemiology
  • +mortality
  • Body Weight Changes
  • Waist Circumference
  • Lipid Metabolism
  • Glucose
  • +metabolism
  • Inflammation
  • C-Reactive Protein
  • Body Mass Index
  • Insulin Resistance
  • Blood Glucose
  • Antipsychotic Agents
  • Serotonin Uptake Inhibitors
  • Benzodiazepines
  • Risk Factors
  • Cholesterol
  • Triglycerides
  • Obesity
  • Metabolic Syndrome
  • Socioeconomic Factors
  • Health Behavior
  • 3124 Neurology and psychiatry

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