Interventioner for forbedring af symptomer på metabolisk syndrom i patienter med skizofreni

Abstract

Baggrund: Metabolisk syndrom er en tilstand med op til flere kliniske komplikationer, herunder abdominal overvægt, dyslipidæmi, forhøjet blodtryk og nedsat insulintolerance. Forekomsten af Metabolisk syndrom er faldet i de seneste årtier, grundet en betydelig indsats indenfor sundhedsområdet. Dette er dog ikke tilfældet for patienter med skizofreni, hvor forekomsten fortsat er stigende, samt årsag til en høj dødelighed. Følgende review har derfor til opgave at foretage en omfattende gennemgang af den tilgængelige litteratur om interventioner mod metabolisk syndrom i patienter med skizofreni, for at diskutere hvilke tiltag der bedst vil kunne hjælpe denne sårbare gruppe. Metoder: Der er foretaget en systematisk søgning i databasen Pubmed, samt litteraturgennemgang i andre reviews om samme emne. Søgningen gav i alt 815 artikler. Efterfølgende blev disse artikler systematiseret og gennemgået ud fra opsatte inklusions- og eksklusionskriterier, samt ud fra værktøjer til at identificere artikler af høj evidens. Resultater: Der blev i alt inkluderet 63 artikler i følgende systematiske review. Den tilgængelige litteratur rummede mange forskellige interventioner, som alle viste at livsstilsændringer i KRAM faktorerne havde en effekt på aspekterne af metabolisk. Litteraturen viste samtidig at effekten oftest kun var midlertidig, hvortil mange artikler pegede på en lav tidshorisont, samt en utilstrækkelig forsøgsopbygning, som ikke var designet en så krævende og sårbar gruppe som skizofrene. Konklusion: Ud fra den systematiske gennemgang af litteraturen, står det klart at de mange nuværende interventioner har en effekt, men at denne enten er meget ringe, eller kun er midlertidig. Mange af studierne pointerer hvor vigtigt det er at være opmærksom på de skizofrenes behov, og opsætte interventionerne efter deres ønsker og begrænsninger, for herved at opnå en bedre og mere vedvarende effekt. På baggrund af dette, har vi formuleret en række tiltag, som vi mener kan komme den høje forekomst af metabolisk syndrom i skizofrene patienter til livs. Disse tiltag kan og bør efterprøves i studier, for derved at dokumentere deres reelle effekt.

Background: Metabolic syndrome represents a dire condition with several clinical complications, including abdominal adiposity, dyslipidemia, elevated blood pressure and inhibited insulin resistance. The presence of metabolic syndrome has declined in the latest decades, due to a considerable health effort. This is not the case for patients with schizophrenia, where cases continue to accumulate, while mortality remains high because of this. The following review will conduct an extensive literature search on possible interventions against metabolic syndrome in patients with schizophrenia, to discuss which interventions are the most effective. Methods: An extensive literature search has been conducted in the database of Pubmed, as well as in similar reviews covering the subject. The search gave a total of 815 articles. These articles were then ordered and analyzed through predetermined including- and excluding factors, as well as by tools to identify articles with a high level of evidence. Results: A total of 63 articles were included in the following review. The available literature held many different interventions, showing that lifestyle changes concerning the KRAM factors had an effect on the parameters of metabolic syndrome. Most studies only had a temporary effect however, as most participants would recede to old habits once the study ended, due to their short duration. The design and methods of many studies were also noted to be insufficient, when aimed at a vulnerable group such as patients with schizophrenia. Conclusion: Having examined the current literature, the current and ongoing interventions has an effect, although rather poor sometimes, and often only temporary. A great deal of studies made it clear how important it is to consider the needs and limitations of patients with schizophrenia, and to take these into considerations when designing and considering new interventions, to achieve a long lasting and solid effect. Based on these findings, we have formulated a number of approaches, which might combat the high occurrence of metabolic syndrome in patients with schizophrenia. These approaches should all be tested in studies, to document their effect.

A master thesis from Aalborg University

Interventioner for forbedring af symptomer på metabolisk syndrom i patienter med skizofreni

[Interventions for improving metabolic syndrome symptoms it patients with schizophrenia]