Endocrine Abstracts

Introduction: Patients in secure forensic psychiatric units are at high risk of developing obesity due to complex interplay of factors including antipsychotic medications, restrictions on freedom and poor motivation to healthy lifestyle and physical activities.

Aim: To establish the prevalence of obesity and metabolic syndrome (MetS) in a secure forensic psychiatric hospital in the Republic of Ireland (ROI).

Methods: We carried out a longitudinal study in the National Forensic Mental Health Service in the (institution name, four words), Dublin. National Cholesterol Educational Program, Adult Treatment Panel III (NCEP/ATP III) definition was used to diagnose MetS.

Results: Number of patients was 76 (males=68 (89.5%)). Mean age was 44.7 years (S.D.=13.4). All patients were on long-term antipsychotics. Duration of admission was longer in males (9.6 years (S.D.=10.5) vs 3.8 (S.D.=2.9) in females, P=0.1232), mean was 9.2 (S.D.=10.2). Mean weight at admission was 90.2 kg (S.D.=17.7), BMI=30.0 kg/m² (S.D.=5.9); this increased at time of study (TOS) to 98.3 kg (S.D.=17.9, P=0.006), BMI=32.8 (S.D.=6.1, P<0.001). Average weight gain was 8.1 kg. At admission, 24 (31.6%) patients were overweight and 35 (46.0%) were obese; at TOS, 9 (11.8%) were overweight and 57 (75%) were obese (P<0.001). Twenty-nine (37.2%) patients met the criteria for MetS at admission, 44 (56.6%) at TOS (the additional 15 met the criteria solely due to weight gain). Three had diabetes at admission, 12 (15.8%) at TOS (P=0.012).

Conclusion: We conclude that obesity and MetS are highly prevalent in our centre. Given that obesity is a significant contributor to MetS and its complications, patients in forensic institutions such as this should receive appropriate weight management programme from time of admission. Urgent investment in dietetic and physiotherapy service is needed.