Osteopenia, pathological fractures, and increased urinary calcium excretion in schizophrenic patients with polydipsia

Delva, Nicholas J.; Crammer, John; Jarzylo, S.V.; Lawson, J. S.; Owen, James; Sribney, Michael; Weir, BA; Yendt, Edmund R.

doi:10.1016/0006-3223(89)90119-4

Cited by 57 publications

(24 citation statements)

References 24 publications

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“…For example, Michelson and his colleagues 44 have shown that pre-menopausal women with depression have lowered bone mineral density while Delva et al 45 Halbriech and Palter 46 have shown similar findings in schizophrenia. Rosmond et al 47 have recently demonstrated that certain types of personality disorders had significantly higher WHRs as compared to controls though the metabolic and endocrine profiles did differ between the three clusters of disorders chosen for study.…”

Section: Discussionmentioning

confidence: 99%

Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia

et al. 2002

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OBJECTIVE:To investigate visceral fat distribution in patients with schizophrenia. DESIGN: Cross sectional study using CT scanning in patients with drug-naive and drug-free schizophrenia. SUBJECTS: Fifteen (13 men and two women) subjects with schizophrenia (mean age 33.7 y; mean body mass index (BMI) ¼ 26.7 kg=m 2 ), and 15 age-and sex-matched controls (mean age 30.5 y; mean BMI ¼ 22.8 kg= 2 ). MEASUREMENTS: Various fatness and fat distribution parameters (by CT scanning and anthropometry) and 16:00 h plasma cortisol. RESULTS: In comparison to controls, patients with schizophrenia had central obesity and had significantly higher levels of plasma cortisol. Furthermore, previous neuroleptic exposure did not appear to influence these findings as both drug-naive and drug-free patients had equally high levels of visceral fat deposition. CONCLUSION: Central obesity is a well recognized risk factor in developing certain general medical conditions. This study shows that patients with schizophrenia have increased intra-abdominal fat which may provide one explanation for why they die prematurely. International Journal of Obesity (2002 Keywords: schizophrenia; cortisol; imaging IntroductionReduced life expectancy is a well recognized feature of psychiatric illness. 1 -3 With respect to schizophrenia, the precise reasons underlying this excessive mortality are as yet unknown. 4,5 However, it is clear that suicide cannot fully account for these findings. 6,7 A meta-analysis of the relevant literature by Harris and Barraclough found that 'unnatural' causes of death such as suicide and accidents were far more likely to occur than expected in patients with schizophrena. 8 However, the standardized mortality ratios for 'natural causes', such as cardiovascular illness, was also significantly increased, a finding which was supported by Allbeck 9 and Ruschena et al. 3 A number of reasons may explain the excessive death rate due to 'natural causes' observed in schizophrenia; these include psychosocial deprivation, an unhealthy lifestyle and psychotropic medication. 10 -12 Yet, the general medical illnesses which tend to occur in those suffering from schizophrenia form a cluster which is termed the metabolic syndrome. 13 Hypertension, type 2 diabetes mellitus and dyslipidaemias are the primary constituents of this syndrome and are associated with increased intra-abdominal fat deposition. 14,15 Abdominal fat distribution consists of two discrete depots, subcutaneous and visceral (intra-abdominal) and numerous variables can account for the pattern of body fat deposition observed in the general population. 16,17 Of note is the fact that cortisol has a marked effect on regional fat distribution, in that patients with Cushing's syndrome who have marked hypercortisolaemia, have increased visceral fat distribution as measured by computerized axial tomography (CT) scanning. 18,19 Indeed, reduction of plasma cortisol in this subgroup of patients leads to a decrease in intra-abdominal fat stores 20 and also a normalization of certain features...

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Section: Discussionmentioning

confidence: 99%

Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia

et al. 2002

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“…The complications are bladder and bowel dilatation, renal and cardiac failure, hydronephrosis, osteopenia, and pathological fractures ). The latter may be due to increased urinary calcium excretion in the polyuria that accompanies polydipsia (Delva et al 1989). The time course is based on retrospective studies of small numbers of patients with particularly severe symptoms, so the time frames for the stages are approx imations.…”

Section: Clinical Features and Natural Historymentioning

confidence: 99%

Neuroendocrine Factors Influencing Polydipsia in Psychiatric Patients: An Hypothesis

Verghese

León

Simpson

1993

Neuropsychopharmacol

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Polydipsia and water intoxication cause considerable morbidity and mortality in chronic psychiatric patients. Polydipsia in psychiatric patients has been described si nce the 1930s prior to the use of neuroleptics, but sys te matic study of the disorder has been done mostly in th e last two decades. There are many names for the dis order, which include psychogenic polydipsia (Bauer 1925), compulsive water drinking (Barlow and De Wardener 1959), psychosis, intermittent hyponatremia and polydipsia (PIP) syndrome (Vieweg et al. 1985) and self-induced water intoxication (Hobson and English 1963). The main purpose of this paper is to propose an hypothesis about the pathophysiology of the disorder and to reconceptualize some of the thinking about it.

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“…Although some studies examined only small samples (range 10-402 patients), thirteen studies published between 1980 and 2005 consistently found decreased bone mineral density (osteoporosis) of people with schizophrenia compared to normal controls (69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). One reason for this finding is that many antipsychotic drugs increase prolactin levels.…”

Section: Musculoskeletal Diseases (316 Medline Hits)mentioning

confidence: 99%

Physical illness and schizophrenia: a review of the literature

Leucht

Burkard

Henderson³

et al. 2007

Acta Psychiatr Scand

564

358

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Sartorius N. Physical illness and schizophrenia: a review of the literature.Objective: The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. Method: We searched MEDLINE (1966( -May 2006 combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. Results: A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. Conclusion: The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients. Summations• According to this review it has been known for decades that incidences physical diseases are frequent in schizophrenia. Nevertheless, some areas such as infectious diseases have not been sufficiently studied.• Psychiatrists are often not trained well enough in the detection and treatment of physical diseases.They must be aware of the frequent medical comorbidities and should play a more active role in their diagnosis, prevention, and treatment.• Other necessary strategies include the education of patients, general practitioners and of doctors working in other medical specialities. The access to medical care of the mentally ill also needs to be improved, among others, by reducing the stigma associated with mental disorders. Considerations• The review covered a broad area of research accordingly, focusing attention to details has not been possible.• Despite the broad search strategy, studies not covered by MEDLINE or not indexed by the MeSH term of schizophrenia could have been missed. • Due to considerable differences in the design and quality of the studies in assorted and diverse areas, quantitative approaches using meta-analysis were not possible, but should be the target of future reviews focusing.

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Osteopenia, pathological fractures, and increased urinary calcium excretion in schizophrenic patients with polydipsia

Cited by 57 publications

References 24 publications

Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia

Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia

Neuroendocrine Factors Influencing Polydipsia in Psychiatric Patients: An Hypothesis

Physical illness and schizophrenia: a review of the literature

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