Faculty Bibliography

OBJECTIVE:There is limited research on metabolic abnormalities in psychotropic-naïve patients with serious mental illness (SMI). Our study examined metabolic conditions in a large, ethnically diverse sample of psychotropic-naïve and non-naïve adults with SMI at an urban public hospital. METHODS:In this cross-sectional study of 923 subjects, the prevalences of hyperglycemia meeting criteria for type 2 diabetes mellitus (T2DM) based on fasting plasma glucose and obesity defined by BMI and abdominal girth were compared across duration of psychotropic medication exposure. Multiple logistic regression models used hyperglycemia and obesity as dependent variables and age, sex, race/ethnicity, and years on psychotropics as independent variables. RESULTS:Psychotropic-naïve patients, including both schizophrenia and non-psychotic subgroups, showed an elevated prevalence of hyperglycemia meeting criteria for T2DM and a decreased prevalence of obesity compared to the general population. Obesity rates significantly increased for those on psychotropic medications more than 5 years, particularly for patients without psychosis (BMI: aOR = 5.23 CI = 1.44-19.07; abdominal girth: aOR = 6.40 CI = 1.98-20.69). Women had a significantly higher obesity rate than men (BMI: aOR = 1.63 CI = 1.17-2.28; abdominal girth: aOR = 3.86 CI = 2.75-5.44). Asians had twice the prevalence of hyperglycemia as whites (aOR = 2.29 CI = 1.43-3.67), despite having significantly less obesity (BMI: aOR = .39 CI = .20-.76; abdominal girth: aOR = .34 CI = .20-.60). Hispanics had a higher rate of obesity by BMI than whites (aOR = 1.91 CI = 1.22-2.99). CONCLUSIONS:This study showed disparities between obesity and T2DM in psychotropic-naïve patients with SMI, suggesting separate risk pathways for these two metabolic conditions.

Zinc dysregulation is linked to neuropsychiatric disorders and a beneficial response to zinc supplementation has been demonstrated for depression. In this case series, we examined serum zinc levels with respect to clinical factors among 20 acutely ill psychiatric cases admitted to a large urban public hospital. The results showed frank clinical zinc insufficiency in a quarter of the subjects. Group-wise analyses showed a significant association between reduced serum zinc and diagnosis of depression, and reduced serum zinc in those with aggressive, assaultive, or violent behaviors. By contrast, relatively elevated zinc levels were observed in a subset of psychotic cases on antipsychotics and mood stabilizers who had no mood symptoms. In summary, clinical zinc insufficiency was common in these acutely admitted psychiatric cases. Zinc supplementation may ameliorate symptoms in certain cases and should be considered in treatment planning. A separate patient group had elevated zinc levels, which could conceivably be pathogenic. Larger studies are needed to confirm and extend this pilot data.

BACKGROUND:High rates of posttraumatic stress disorder (PTSD) and depressive symptoms have been observed in earthquake survivors from less developed areas of the world. This study, conducted three years after the 2005 Pakistan earthquake, aimed to identify potentially protective psychosocial factors associated with lower PTSD and depressive symptom levels. METHODS:Adult earthquake survivors (N=200) were recruited from affected areas in Northwestern Pakistan and completed self-report questionnaires measuring PTSD and depressive symptoms, positive and negative affect, and four psychosocial variables (purpose in life, positive and negative religious coping, and social support). RESULTS:Sixty five percent of participants met criteria for probable PTSD. Purpose in life was associated with lower symptom levels and higher positive emotions. A form of negative religious coping (feeling punished by God for one's sins or lack of spirituality) was associated with higher symptom levels and negative emotions. Higher perceived social support was associated with higher positive emotions. Other significant relationships were also identified. LIMITATIONS/CONCLUSIONS:Limitations include the recruitment of a sample of convenience, a modest sample size, and the cross-sectional nature of the study. CONCLUSIONS:Findings suggest that some psychosocial factors may be protective across cultures, and that the use of negative religious coping is associated with poorer mental health outcomes in earthquake survivors. This study can inform preventive and treatment interventions for earthquake survivors in Pakistan and other less industrialized countries as they develop mental health care services.

Although previous studies have documented the psychological impact of earthquakes, less is known about potentially protective characteristics associated with healthier outcomes. In the present study, 2 samples of survivors were recruited from remote villages in Northwestern Pakistan, 7 and 19 months after the devastating October 2005 earthquake. Female gender, lower education, and closer proximity to the epicenter predicted significantly higher posttraumatic symptom levels. After adjusting for demographic characteristics, distance from the epicenter, and death of close relatives, higher dispositional optimism and higher scores on the Connor-Davidson Resilience Scale were significantly associated with lower symptom levels. The authors' findings in a previously unstudied population suggest that certain potentially protective mechanisms, such as optimism, may be universal regardless of culture of origin