Metabolic disturbances are risk factors for readmission to psychiatric hospitals in non-smokers but not in smokers: results from a Swiss psychiatric cohort and in first-episode psychosis patients

Nermine Laaboub; Isabella Locatelli; Claire Grosu; Marianna Piras; Tram Ho Ngoc; Setareh Ranjbar; Martin Preisig; Julien Elowe; Armin von Gunten; Philippe Conus; Chin B Eap

doi:10.3389/fpsyt.2024.1256416

Metabolic disturbances are risk factors for readmission to psychiatric hospitals in non-smokers but not in smokers: results from a Swiss psychiatric cohort and in first-episode psychosis patients

Front Psychiatry. 2024 Feb 13:15:1256416. doi: 10.3389/fpsyt.2024.1256416. eCollection 2024.

Authors

Nermine Laaboub¹, Isabella Locatelli², Claire Grosu¹, Marianna Piras¹, Tram Ho Ngoc¹, Setareh Ranjbar³, Martin Preisig³, Julien Elowe⁴, Armin von Gunten⁵, Philippe Conus⁶, Chin B Eap^{1

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Affiliations

¹ Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland.
² Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
³ Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland.
⁴ Service of Adult Psychiatry North-West, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland.
⁵ Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland.
⁶ Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland.
⁷ School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
⁸ Center for Research and Innovation in Clinical Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland.
⁹ Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.

Abstract

Background: Psychiatric patients are at high risk of readmission, and a high body mass index has previously been shown as a risk factor. We sought to replicate this finding and 1) to prospectively assess the association of metabolic syndrome and its five components with readmission in psychiatric hospitals and 2) to identify other clinical and sociodemographic predictors of readmission.

Methods: Between 2007 and 2019, data on 16727 admissions of 7786 adult and elderly patients admitted to the Department of Psychiatry of the Lausanne University Hospital, were collected. Metabolic syndrome was defined according to the International Diabetes Federation definition. Cox frailty models were used to investigate the associations between readmission and metabolic disturbances.

Results: A total of 2697 (35%) patients were readmitted to our psychiatric hospital. Novel risk factors for readmission in non-smokers were identified, including being overweight (HR=1.26; 95%CI=[1.05; 1.51]) or obese (HR=1.33; 95%CI=[1.08; 1.62]), displaying hypertriglyceridemia (HR=1.21; 95%CI=[1.04; 1.40]) and metabolic syndrome (HR=1.26; 95%CI=[1.02; 1.55]). Central obesity and hyperglycemia increased the risk of readmission when considering the Health of the Nation Outcome Scales variable. In first-episode psychosis patients, obesity (HR=2.23; 95%CI=[1.14; 4.30]) and high-density lipoprotein hypocholesterolemia (HR=1.90; 95%CI=[1.14; 3.20]) doubled the risk of readmission.

Conclusion: The observed interaction between smoking and metabolic variables are compatible with a ceiling effect; metabolic variables increase the risk of readmission in non-smokers but not in smokers who are already at higher risk. Future studies should determine whether better metabolic monitoring and treatment can reduce readmission risk.

Keywords: first-episode psychosis; metabolic disturbances; metabolic syndrome; psychiatry; readmission; relapse.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work has been funded in part by the Swiss National Research Foundation (Grants ID: 320030-120686, 324730-144064, 320030-173211; and 320030-200602). The funding sources had no role in the writing of the manuscript or in the decision to submit it for publication.