Despite the fact that antipsychotic medication increases the risk of metabolic syndrome (MetS), the rate of MetS among psychiatric patients in Indonesia is rarely reported. This study aimed to investigate the prevalence of MetS among inpatients with schizophrenia in Indonesia. Eighty-six hospitalised psychiatric patients with schizophrenia were randomly recruited, and underwent physical examination including a blood test. MetS was assessed based on the International Diabetes Federation (IDF) criteria for South Asia. Among the sample, only eight patients (9.3%) met the IDF criteria for MetS. Women have a higher rate of MetS than men (23.8% vs 4.6%; p = 0.02). Reduced high-density lipoprotein (HDL) cholesterol was the most frequent (81.4%) metabolic abnormality among them, followed by central obesity (29.1%), raised triglycerides (23.3%), raised fasting plasma glucose (12.8%), and raised blood pressure (10.5%). Among the various antipsychotics, no differences in MetS prevalence were observed in this population. The rate of MetS among the psychiatric inpatients in this study is lower compared both to the previously reported rate in the general population and to the findings among psychiatric patients with schizophrenia in developed countries. Several factors related to the reduced rate of MetS in this psychiatric inpatient population will be discussed.
Schizophrenia is a severe and chronic mental disorder that requires long-term medical treatment. The introduction of first-generation antipsychotics in the 1950s and second-generation antipsychotics in the 1980s have helped to gradually alleviate the suffering of patients with schizophrenia (Kane, 1999). While second-generation antipsychotics or atypical antipsychotics have been found to be highly effective in particular against positive symptoms in schizophrenia, they have also been found to alter the patient's appetite, weight, serum glucose and their response to insulin (Mathews and Muzina, 2007). These changes are often related to the development of a metabolic syndrome (Mendelson, 2007). Metabolic syndrome constitutes several interrelated abnormalities including obesity, insulin resistance, dyslipidemia, impaired glucose tolerance and hypertension (Newcomer, 2005 and Reaven, 1999). Many studies and meta-analyses have suggested the exacerbating effects of antipsychotics on the development of MetS (Kannabiran and Singh, 2008, McIntyre et al., 2001, Mitchell et al., 2013 and Rummel-Kluge et al., 2010). The severity of the effects varied depending on the type of medication (Rummel-Kluge et al., 2010). Nevertheless, increasing rates of cardiovascular disease, physical morbidity and premature mortality as the result of psychiatric medications have become a major concern (De Hert et al., 2011 and Saha et al., 2007). The treatment of individuals with schizophrenia, therefore, should also consider the possible metabolic outcomes.
The prevalence of MetS risk factors is high among individuals with schizophrenia. A meta-analysis by Mitchell et al. (2013) suggested an overall MetS rate of 32.5%, with a relatively small difference between the rates among in- and out-patients (30.4% for inpatients vs. 31.8% for outpatients). Mitchell et al. (2013) also found that age and duration of illness had a modest influence on the rate of MetS, while country of origin, definition criteria of MetS and gender had only a minor to no appreciable effect.
The rates of MetS among individuals with schizophrenia have been reported for some Southeast Asian countries, with 46% in Singapore (Lee et al., 2012), 35 to 37% in Thailand (Suttajit and Pilakanta, 2013), and 46.7% in Malaysia (Said et al., 2012). The rate of MetS in the general population of Indonesia was 28.4%, with hypertension being the most common metabolic abnormality in men and central obesity in women (Soewondo et al., 2010). Moreover, the rate of MetS among elderly Indonesians was 18.2% and 6.6% in women and men, respectively (Kamso, 2008). Until the time of this study, no data on the prevalence of MetS and factors associated with MetS among individuals with mental disorders in Indonesia has been available.
In addition, despite the guidelines for monitoring blood profiles during the prescription of the second generation of APs (De Hert et al., 2006 and Horn et al., 2012), blood tests are rarely performed in some psychiatric hospitals in Indonesia. This study therefore aimed to investigate the prevalence rate of MetS among inpatients with schizophrenia in a large psychiatric hospital in Indonesia.
The prevalence of MetS among psychiatric inpatients with schizophrenia in a psychiatric hospital in Indonesia might be lower than previously reported in western industrialised countries. However, regular blood monitoring should be implemented in order to help identify any alterations in metabolic abnormality. Where the supply and equipment for laboratory tests is limited, changes in weight and waist measurement of patients taking APs could be monitored as an alternative. Socio-economic factors such as poverty, social support and access to food, and specifically nutritional intake during hospitalisation, should be a concern of the stakeholders in order to improve the quality and outcomes of the treatment. Lastly, further studies on MetS in this region should consider those outpatients taking APs, have a larger sample size, and include at least one control group from the reference population.
