METABOLIC RISK FACTORS AND WEIGHT GAIN IN PEOPLE ADMITTED TO A PSYCHIATRIC INTENSIVE CARE UNIT

Background: People with psychotic disorders have increased rates of obesity, metabolic syndrome and diabetes. During hospitalisation poor dietary choices and limited opportunity to exercise may be associated with weight gain. The effects of medications (especially atypical antipsychotics) on appetite are also important. This study assessed serum glucose, cholesterol and lipids in people with acute psychiatric disorders on admission to a closed psychiatric intensive care unit. We examined changes in weight and BMI during the admission. Methods: 119 consecutively admitted patients were included in the study. All patients are involuntary. The average length of stay was 9.3 days. Data collected included demographic variables, height and weight at admission, weight at discharge, psychiatric diagnosis, medications given, fasting blood glucose and lipids, and duration of admission. Patients could choose freely the type and quantities of food they ate, and were able to obtain snack foods from the hospital canteen and a nearby supermarket. Results: Five patients refused to participate. Of the remaining 114 clients, 70 (61%) were male with a mean age of 35 years. The most common diagnoses were non-affective psychosis (67%) and bipolar disorder (19%). The mean BMI was 27.04 (mean weight 82.5 kg) on admission and 27.8 (mean weight 84.9 kg) at discharge, a mean weight gain of 2.45 kg. Fasting blood samples on admission showed abnormally high levels of glucose in 25%, cholesterol in 9% (with a further 16% borderline) and LDL in 9% of patients. Discussion: This study shows that on admission a significant proportion of acutely unwell patients have elevated blood glucose, cholesterol and lipids. On average, their BMI increased 0.09 units per day of hospitalisation. A policy of recovery-oriented practise was interpreted to allow patients free choice of foods. Our results suggest that the context needs to be considered in the provision of recovery focussed treatment. This should include providing healthy foods, limiting access to high carbohydrate foods, and encouraging regular exercise, within the constraints of this type of treatment facility.