Metabolic Syndrome

The metabolic syndrome (MetSyn) is a predictor of diabetes and cardiovascular diseases, and it is more prevalent in psychiatric patients than in the general population. Some antipsychotic medication increases the risk of MetSyn, and since patients with schizophrenia is over-represented among Danish forensic psychiatric patients, the risk of developing MetSyn is high in this population. MetSyn has attention in the Danish health care system however, knowledge of how MetSyn prevention should be implemented is scarce. We do not know how a forensic psychiatric hospitalization affects the risk of developing MetSyn, hence, we do not know whether MetSyn prevention should target inpatients or outpatients. Furthermore, little is known about physical activity and dietary behaviours in forensic psychiatric patients, therefore we do not know which physical activity and dietary behaviours to target the prevention at. Finally, we do not know the barriers and facilitators or motivators for improvement in physical activity and dietary behaviours in forensic psychiatric patients. Therefore, it is not possible to take these into consideration in the implementation of MetSyn prevention at present. The overall aim of this project is to generate knowledge, which is fundamental for development of future lifestyle interventions preventing MetSyn in Danish forensic psychiatric patients.

Anne Louise Winkler Pedersen, Frederik Alkier Gildberg, Peter Hjorth, Mikkel Højlund & Kjeld Andersen, 2022. Hospitalisation time is associated with weight gain in forensic mental health patients with schizophrenia or bipolar disorder, Nordic Journal of Psychiatry, DOI: 10.1080/08039488.2022.2053202

Introduction: People with mental disorders have higher mortality from lifestyle diseases than the general population. Forensic mental health patients (FMHPs) are often hospitalised for longer periods of time than non-FMHPs. Thus, hospitalisation may have a greater effect on the risk of lifestyle diseases in FMHPs.

Objective: Investigate associations between proportional hospitalisation time (PHT) and change in body weight or other cardiometabolic risk factors among FMHPs.

Methods: Retrospective cohort study including all FMHPs with schizophrenia or bipolar disorder, prescribed antipsychotics, and treated between 01 January 2016 and 06 April 2020 in the Region of Southern Denmark either in forensic units or as outpatients. Associations between PHT and, respectively, primary and secondary outcomes were analysed using linear regression. PHT was determined between each measurement of the outcomes as the number of days hospitalised divided by the total number of days within the time-period. The primary outcome was weight change and secondary outcomes were change in waist circumference (WC), blood pressure, estimated average glucose (eAG), HDL, LDL, total cholesterol, and triglycerides. Analyses were adjusted for gender, age, smoking, and antipsychotics.

Results: The cohort included 490 FMHPs, of which 440 were diagnosed with schizophrenia. PHT had a significant positive dose-response association with weight change, with an estimated difference of þ4.0 kg/year for FMHPs who
were hospitalised 100% of the time, compared to FMHPs who were exclusively treated as outpatients. The association interacted with baseline BMI. From the secondary outcomes, the association with PHT was only statistically significant for WC.

Conclusions: PHT was positively associated with weight gain.

Pedersen, ALW., Rosendal LC., Hjorth, P., Andersen, K., Gildberg, FA. 2020. Title: Health behaviours of forensic mental health service users, in relation to smoking, alcohol consumption, dietary behaviours and physical activity – A mixed methods systematic review. Journal of Psychiatric and Mental Health Nursing. Status: Published

Introduction: People with mental disorders have increased risk of dying from diabetes and cardiovascular diseases, both of which can be prevented by lifestyle.
Aim: To review existing research, in order to investigate the characteristics of, and factors that influence forensic mental health service users’ (FMU) health behaviours.
Method: We searched PubMed, CINAHL, PsycInfo and Scopus for primary research on FMU’s health behaviours regarding smoking, alcohol consumption, physical activity and dietary behaviours, and factors that influence them.
Results: We found 13 eligible studies. The findings consistently indicated the presence of unfavourable health behaviours in FMU: Smoking, problematic alcohol consumption, physical inactivity and a high-calorie diet of poor nutritional value. Changing smoking and dietary habits was perceived as difficult, but nicotine replacement and practical advice were suggested to support change.
Discussion: The existing research on FMU’s health behaviours is sparse. In particular, there is a lack of research on factors that influence health behaviours. From our findings, it seems likely that FMU’s unfavourable health behaviours contribute to their increased risk of dying from diabetes and cardiovascular diseases.
Implications for practice: FMU’s health behaviours should be improved to prevent diabetes and cardiovascular diseases in this high-risk group.

crime and mental health, forensic, health promotion, prevention, systematic literature reviews