Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study

IMPACT team

doi:10.1192/bjp.2019.159

Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study

IMPACT team

Professor in Medical Statistics and Statistical Learning, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
Statistician, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
Consultant Diabetologist, Institute Director and Clinical Academic Group Lead, Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, UK.
Senior Lecturer, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
University of Sussex
Director, Anita Patel Health Economics Consulting Ltd; and Honorary Professor, Queen Mary University of London, UK.
Clinical Senior Lecturer, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; and Consultant Psychiatrist, Forensic Services, South London and Maudsley NHS Foundation Trust, UK.
Clinical Trials Manager, University College London, UK.
Visiting Researcher, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and the Royal College of Surgeons in Ireland.
Research Fellow and Honorary Lecturer, Kings' Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
NIHR Lecturer, Department of Psychological Medicine, Institute of Psychiatry, King's College London; and Head of Physiotherapy, Physiotherapy Department, South London and Maudsley NHS Foundation Trust, UK.
Consultant Psychiatrist, C&I Foundation Trust; and Visiting Lecturer, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
Clinical Informatics Interface and Network Lead, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
Director of Pharmacy and Pathology and Head of Pharmaceutical Sciences Clinical Academic Group, King's Health Partners, South London and Maudsley NHS Foundation Trust, UK.
MRC Clinician Scientist, Department of Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; the South London and Maudsley NHS Foundation Trust, UK; and Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy.
Professor of Mental Health, Director and Sackler Chair, Institute of Mental Health, Division of Psychiatry, University College London, UK.
Professor of Psychiatric Research, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; the South London and Maudsley NHS Foundation Trust, UK; and Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy.
Professor of Psychiatry and Medicine, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.

AIMS: We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.

METHOD: This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.

RESULTS: Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).

CONCLUSIONS: Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.

Original language	English
Pages (from-to)	712-719
Number of pages	8
Journal	British Journal of Psychiatry
Volume	215
Issue number	6
Early online date	26 Jul 2019
DOIs	https://doi.org/10.1192/bjp.2019.159
Publication status	Published - Dec 2019

Keywords

First episode psychosis
cardiometabolic risk
ethnicity
glucose dysregulation
weight

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

@article{234016d4e54246cc872ab6e7f33538be,

title = "Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study",

abstract = "BACKGROUND: The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.AIMS: We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.METHOD: This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.RESULTS: Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).CONCLUSIONS: Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.",

keywords = "First episode psychosis, cardiometabolic risk, ethnicity, glucose dysregulation, weight",

author = "{IMPACT team} and Fiona Gaughran and Daniel Stahl and Dominic Stringer and David Hopkins and Zerrin Atakan and Kathryn Greenwood and Anita Patel and Shubulade Smith and Poonam Gardner-Sood and John Lally and Margaret Heslin and Brendon Stubbs and Stefania Bonaccorso and Anna Kolliakou and Oliver Howes and David Taylor and Forti, {Marta Di} and David, {Anthony S} and Murray, {Robin M} and Khalida Ismail",

year = "2019",

month = dec,

doi = "10.1192/bjp.2019.159",

language = "English",

volume = "215",

pages = "712--719",

journal = "British Journal of Psychiatry",

issn = "0007-1250",

publisher = "Cambridge University Press",

number = "6",

}

TY - JOUR

T1 - Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis

T2 - prospective cohort study

AU - IMPACT team

AU - Gaughran, Fiona

AU - Stahl, Daniel

AU - Stringer, Dominic

AU - Hopkins, David

AU - Atakan, Zerrin

AU - Greenwood, Kathryn

AU - Patel, Anita

AU - Smith, Shubulade

AU - Gardner-Sood, Poonam

AU - Lally, John

AU - Heslin, Margaret

AU - Stubbs, Brendon

AU - Bonaccorso, Stefania

AU - Kolliakou, Anna

AU - Howes, Oliver

AU - Taylor, David

AU - Forti, Marta Di

AU - David, Anthony S

AU - Murray, Robin M

AU - Ismail, Khalida

PY - 2019/12

Y1 - 2019/12

N2 - BACKGROUND: The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.AIMS: We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.METHOD: This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.RESULTS: Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).CONCLUSIONS: Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.

AB - BACKGROUND: The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.AIMS: We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.METHOD: This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.RESULTS: Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).CONCLUSIONS: Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.

KW - First episode psychosis

KW - cardiometabolic risk

KW - ethnicity

KW - glucose dysregulation

KW - weight

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U2 - 10.1192/bjp.2019.159

DO - 10.1192/bjp.2019.159

M3 - Article

C2 - 31347480

SN - 0007-1250

VL - 215

SP - 712

EP - 719

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

IS - 6

ER -

Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study

Abstract

Keywords

UN SDGs

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