Objective: To describe pretreatment cardiometabolic constitution in children and adolescents with first-episode psychosis (FEP).
Methods: Baseline cardiometabolic assessment was performed in youths aged 12-17 years with FEP entering the Tolerability and Efficacy of Antipsychotics (TEA) trial and matched healthy controls. Patients were included between June 10, 2010, and January 29, 2014. ICD-10 was used as the diagnostic classification system. Cardiometabolic risk markers were compared between patients versus controls and antipsychotic-naive versus antipsychotic-exposed patients.
Results: Comparing 113 youths with FEP (age ± SD = 15.74 ± 1.36 years, males = 30.1%, schizophrenia-spectrum disorders = 92.9%, antipsychotic-naive: n = 57) to 60 controls, patients had higher waist circumference (WC) z scores (1.13 ± 1.65 vs 0.42 ± 1.27, P = .018), cholesterol (4.10 ± 0.71 vs 3.79 ± 0.49 mmol/L, P = .014), low-density lipoproteins (2.37 ± 0.56 vs 2.13 ± 0.51, P = .012), and non-high-density lipoproteins (2.58 ± 1.60 vs 2.52 ± 0.52, P = .018). More patients than controls (42.9% vs 20.3%, P = .019) and antipsychotic-naive than antipsychotic-exposed (51.9% vs 34.0%, P = .023) had a WC > 90th percentile. Hypercholesterolemia (34.0% vs 12.5%, P = .015) was more frequent in patients, while decreased high-density lipoprotein cholesterol was more frequent in controls (32.5% vs 19.0%, P = .032). Family history of type 2 diabetes mellitus was associated with increased body mass index (BMI) z score (P < .001), WC z score (P = .001), insulin (P = .038), and homeostatic model assessment of insulin resistance (HOMA-IR; P = .025). Dyslipidemia was associated with significantly increased insulin (P = .041), HOMA-IR (P = .032), and low-density lipoprotein cholesterol (P = .041). Previous antipsychotic exposure was not associated with increased cardiometabolic risk. Early age at onset predicted increased BMI and WC z scores, while diagnosis of schizophrenia and higher Clinical Global Impression-Severity score were associated with increased blood lipids.
Conclusions: Youths with FEP had significantly greater WC and lipid abnormalities than matched controls, regardless of antipsychotic exposure. In youths with FEP, elevated metabolic risk predates antipsychotic exposure.
Trial registration: ClinicalTrials.gov identifier: NCT01119014; European Clinical Trials Database (EudraCT): 2009-016715-38.
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