Short summary

The metabolic syndrome is a predictor of diabetes and cardiovascular diseases, and it is more prevalent in psychiatric patients than in the general population. The metabolic syndrome has attention in the Danish health care system however, knowledge of how prevention should be implemented is scarce. The overall aim of this project is to generate knowledge, which is fundamental for development of future lifestyle interventions preventing the metabolic syndrome in Danish forensic psychiatric patients

Rationale

People with mental disorders have shorter life expectancy than the general population, and diabetes and cardiovascular diseases are some of the causes of the increased mortality. The metabolic syndrome is a predictor of diabetes and cardiovascular diseases, and it is more prevalent in psychiatric patients than in the general population. Obesity and physical inactivity are important modifiable risk factors for metabolic syndrome, and lifestyle is suggested to be an important cause of the higher prevalence of metabolic syndrome in psychiatric patients. Furthermore, side effects of medication are also an important factor, since some antipsychotics have adverse effects on blood lipids, body weight, and blood glucose homeostasis.

Patients with a diagnosis of schizophrenia is over-represented in Danish forensic psychiatric patients, and 54.2 % suffered from the diagnoses ICD-10; 20-29 in 2010. Since some antipsychotic medication increases the risk of metabolic syndrome, the risk of developing metabolic syndrome is high in Danish forensic psychiatric patients. The metabolic syndrome has attention in the Danish health care system since psychiatric patients taking antipsychotic medication or having a BMI above 29 are regularly screened for metabolic syndrome. However, there is a paucity of knowledge of how metabolic syndrome prevention should be implemented in forensic psychiatric patients.

We do not know how a forensic psychiatric hospitalization affects the risk of developing metabolic syndrome, hence, we do not know whether 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 metabolic syndrome prevention at present.

The overall aim of this project is to generate knowledge, which is fundamental for development of future lifestyle interventions preventing metabolic syndrome in Danish forensic psychiatric patients. This project will investigate where metabolic syndrome prevention should be implemented, which physical activity and dietary behaviours it should target, and which barriers, facilitators, and motivators to consider in the implementation.

 Objectives:

1. Investigate the association between the cumulative hospitalization time and the risk of developing metabolic syndrome in Danish forensic psychiatric patients.
2. Investigate physical activity, dietary, and smoking behaviours and motivation for change in Danish forensic psychiatric inpatients and outpatients.
3. Investigate barriers, facilitators, and motivators for improvement in physical activity, dietary, and smoking behaviours in Danish forensic psychiatric inpatients or outpatients depending on who showed the highest risk of Metabolic syndrome in objective 1.

Description of the cohort

The participants are forensic psychiatric inpatients and outpatients affiliated to the region of Southern Denmark. They take antipsychotic medication and/or have a BMI above 29.

The retrospective cohort includes patients who were affiliated to the region of Southern Denmark from 2011undtill today.

Data and biological material

In the retrospective cohort, we collect the following data from medical journals (dates for registration will also be collected):

• Presence of metabolic syndrome
• Waistcircumference
• Triglycerides
• HDL cholesterol
• LDL cholesterol
• Total cholesterol
• Blod pressure, systolic and diastolic
• Heart rate
• Fasting blood glucose
• HbA1c
• BMI or weight and height
• Inpatient or outpatient
• Diagnosis (ICD-10)
• PANSS score
• Number of ambulant contacts
• Is the patient psychotic?
• Substance abuse (ICD-10 F10-F19)
• Smoking
• Sex
• Age
• Education
• Civil status
• Household composition

In the survey, we collect questionnaire answers on diet and motivation for healthier eating. Furthermore, the questionnaire will contain questions regarding physical activity and motivation for physical activity.

Collaborating researchers and departments

Dept. of Psychiatry Middelfart, Region of Southern Denmark. CPS, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark

• Associate Professor Frederik A. Gildberg, PhD, MScN, RN

Dept. of Psychiatry Odense, Region of Southern Denmark.

• Professor Kjeld Andersen, Consultant of psychiatry, PhD

Dept. of Psychiatry Vejle, Region of Southern Denmark. CPS, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark

• Post doc Peter Hjorth, Ph.D., MPH, RN

Publications associated with the project

Pedersen ALW, Lindekilde CR, Andersen K, Hjorth P, Gildberg FA. Health behaviours of forensic mental health service users, in relation to smoking, alcohol consumption, dietary behaviours and physical activity-A mixed methods systematic review. J Psychiatr Ment Health Nurs. 2021 Jun;28(3):444-461. doi: 10.1111/jpm.12688. Epub 2020 Oct 11. PMID: 32916759.