High BMI has been associated with psychiatric rehospitalisation.

We aimed to replicate this finding in a large Swiss psychiatric cohort and to examine whether other metabolic disturbances are independently associated with psychiatric readmission.

Data on 16’727 hospitalizations of 7’786 patients admitted between January 1st, 2007 and December 31st, 2019 at the Department of Psychiatry of the Lausanne University Hospital, were collected. Metabolic syndrome was defined according to International Diabetes Federation definition. Generalized Linear Mixed Models were used to investigate the associations between psychiatric readmission and metabolic syndrome and/or its five components.

The readmitted population (N=2’935; 37.7% patients) had higher BMI, and were more likely to have central obesity, hypertriglyceridemia, and hypertension. Multivariate analyses confirmed that having a BMI ≥ 25 kg.m-2 was associated with psychiatric readmission (25 kg.m-2≤ BMI< 30 kg.m-2: OR = 1.88; 95%CI [1.55-2.29]; BMI≥30 kg.m-2: OR = 3.5; 95%CI [2.85-4.30]) when compared to patients with 18.5≤BMI<25 kg.m-2. Interestingly, novel factors associated with readmission were identified including metabolic syndrome (OR = 1.57, 95%CI [1.05-2.33]), central obesity (OR = 1.81, 95%CI [1.33-2.46]), hypertriglyceridemia (OR = 1.59; 95%CI [1.38-1.83]), HDL hypocholesterolemia (OR = 1.22; 95%CI [1.06-1.40]) and hyperglycemia (OR = 1.58; 95%CI [1.35-1.85]).

Metabolic syndrome, central obesity, hypertriglyceridemia, HDL hypocholesterolemia, hyperglycemia and obesity were associated with psychiatric readmission. Possible causes will be presented and discussed (e.g. reduced adherence to treatment in patients with metabolic disorders, multiple psychotropic treatments in non-responders increasing the risk of metabolic worsening).

No significant relationships.

Despite the huge progression in depression treatment, many individuals do not achieve full recovery. Studies demonstrated alternatives from neurotransmitter targets which are promising to predict and manage illness.

This study aimed to select metabolic factors linked to the severity of depression symptoms.

66 patients (36% males) with episode of depression from part of SANGUT study were assessed for laboratory biomarkers (insulin, glucose, ALT, AST, lipid profile, cortisol, hs-CRP), anthropometric measurements (BMI, body composition, WHR ratio) and severity of subjective depressive (BDI scale) and stress (PSS-10 scale) symptoms.

Maximum accuracy for differentiating mood symptoms was achieved by the combination of triglycerides (cut-off point > 101 mg/dl) and HDL cholesterol (cut-off point <=48 mg/dl). For differentiating stress symptoms the combination of cholesterol LDL (cut-off point > 108.35 mg/dl) and hs-CRP (cut-off point <=1.55 mg/dl) were most accurate. In the regression analysis model, total; LDL and HDL cholesterol, adjusting for HOMA-ir, cortisol, hs-CRP, triglycerides, age and body fat content were independently related to mood symptoms severity and explain 23.4% variability. Stress symptoms were related to cortisol, hs-CRP levels and WHR ratio adjusted for age, duration of illness, LDL cholesterol, and body fat content. The following model explains 19% variability of symptoms severity.

In patients with mood disorders, more attention should be paid to metabolic changes, predicting intensified depression traits. The results indicate lifestyle changes as an available to all patients tool for depression management.

No significant relationships.

Atypical antipsychotics offer clear advantages in the management of schizophrenia, compared with conventional neuroleptics, but weight gain is a significant adverse effect with some of these agents.

To review the literature on weight gain associated with atypical antipsychotic treatment in schizophrenia.

Relevant sources were identified from Medline searches to February 2003 using combinations of keywords including ‘schizophrenia’, ‘antipsychotics’, ‘weight gain’, ‘adverse events’, ‘obesity’, and ‘diabetes’.

Most atypical antipsychotics induce some weight gain, but the magnitude of the effect varies markedly. The greatest increases are seen with clozapine and olanzapine: risperidone has a slight effect, comparable with that of conventional neuroleptics, while ziprasidone and aripiprazole appear from current data to have little effect. In addition, atypical antipsychotics have been associated with metabolic disturbances, particularly glucose dysregulation and dyslipidemia. These effects tend to be more marked with olanzapine and clozapine than with other agents. Weight gain associated with atypical antipsychotics imposes substantial morbidity, in addition to that associated with schizophrenia itself. Furthermore, weight gain can significantly impair patients' quality of life, and leads to non-adherence with treatment. Effective weight management should include the selection of an appropriate atypical antipsychotic and for effective weight management, as well both diet and exercise, formal weight management programs tailored to the needs of schizophrenic patients may be useful, and some patients may benefit from weight-reducing drugs.

Weight gain associated with atypical antipsychotics is a common problem that requires effective management. The selection of an agent with a low risk of weight gain, such as risperidone or ziprasidone, is central to such management.