Cardiovascular risk in a first-episode psychosis sample: a 'critical period' for prevention?

OBJECTIVE: Studies in first episode psychosis samples about status of cardiovascular risk factors have shown discordant results. We aimed to determine the 10-year risk of developing coronary heart disease in a sample of first episode psychosis patients referred to an early intervention clinic and compared the same with age, gender, and race matched controls from the U.S. National Health and Nutrition Examination Survey (NHANES). METHOD: We conducted a cross-sectional analysis of baseline data of 56 subjects enrolled in first episode psychosis clinic from April 2006 to January 2010. This sample was compared with age, gender, and race matched 145 individuals drawn from NHANES 2005-2006 database. Sociodemographic and clinical variables were collected. Physical examination including laboratory evaluation was used to screen for common medical illnesses. The 10-year risk of developing coronary heart disease was calculated by using a tool developed by the National Cholesterol Education Program (NCEP-ATP III). RESULTS: There were elevated rates of smoking (46%) and hypertension (11%) albeit statistically significant differences from the control could not be demonstrated for these measures or weight, body mass index, or total or HDL cholesterol, fasting plasma glucose, status of diabetes and impaired fasting plasma glucose, HbA1C level. The 10-year median (range) risk of developing coronary heart disease in patients and controls was 1 (0-5)% and 0 (0-9)% respectively. The difference was not statistically significant. CONCLUSIONS: First episode psychosis patients do not present with significantly higher cardiovascular risk than age and race-matched controls despite clinically significant prevalence of individual risk factors. This sample presents an opportunity for early intervention for the primary prevention of cardiovascular morbidity and mortality.

[The association between disability and residual symptoms in depressive patients: a 3-month follow-up]. / Depresyon Tanisi Alan Hastalarda Kalinti Belirtilerin Yetiyitimi ile Iliskisi: 3 Aylik Izlem Calismasi.

OBJECTIVE: In this 3-month naturalistic follow-up we aimed to investigate depression treatment outcome and the correlation between improvement of depressive symptoms and level of disability. METHOD: The study included 104 patients with depression that presented to the Hacettepe Psychiatry Outpatient Clinic. The course was defined operationally using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders. The World Health Organization Disability Assessment Schedule (WHO-DAS II) was administered to determine level of disability. Patients received follow-up assessments using the same instruments 3 months after receiving antidepressant treatment. RESULTS: Follow-up assessments showed that improvement in Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale total scores was statistically significant, and lower anxiety and depression ratings were correlated with lower disability levels. The patients that had severe depression and anxiety at the beginning of the course had residual depressive symptoms. The results showed that severity of depression was a predictor of residual symptoms in our cohort. Psychological anxiety was the most common residual symptom (consistent with other studies) and the patients with a psychological anxiety score > or = 2 had higher disability levels (Z = -3.570, P < 0.05). CONCLUSION: Severity of depression was a predictor of residual symptoms and partial remission after a depressive episode appeared to be strongly associated with disability. These findings highlight the importance of adequate treatment of depression.