The heart of the matter: Cardiometabolic care in youth with psychosis

Eastern Suburbs Mental Health Programme, Bondi Centre, Sydney, New South Wales, Australia.
Early Intervention in Psychiatry (Impact Factor: 1.95). 01/2012; 6(3):347-53. DOI: 10.1111/j.1751-7893.2011.00315.x
Source: PubMed


Weight gain, obesity and metabolic disturbances in youth with psychosis are significant contributors to the health burden of people with psychosis, with a two- to threefold increase in rates compared with the general population and a 20% reduction in life expectancy. Several studies have now described cardiometabolic benefits of a range of interventions, including a structured diet and exercise programmes and metformin for patients receiving antipsychotic medications. Despite the development of Australian consensus guidelines and screening algorithms to detect such metabolic abnormalities, there is a lack of guidelines for clinicians to determine appropriate, timely, targeted prevention and intervention to manage these complications in the youth population.
The Bondi Early Psychosis Programme targets young people (aged 15-25 years) experiencing their first episode of psychosis. This service has developed a model of metabolic screening and a treatment algorithm to provide clinicians with recommendations for targeted interventions.
Positive Cardiometabolic Health: an early intervention framework for patients on psychotropic medication describes a method for early detection, prevention and intervention strategies targeting antipsychotic-induced metabolic abnormalities and cardiovascular risk factors.
Although further research is required, there is sufficient evidence to support early intervention and prevention strategies to improve physical health outcomes in young people with first-episode psychosis.

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Available from: Jackie Curtis,
    • "In particular, emerging adults (16–25 years of age) and those in their mid-to late-20s with mental illness, and individuals with first episode psychosis (FEP) experience compromised physical health (McCloughen et al., 2012). Metabolic disturbances (Curtis, Newall, & Samaras, 2012), nicotine and substance use (Hermens et al., 2013), and antipsychotic medications (Eapen, Shiers, & Curtis, 2012) contribute to the health burden of young people with mental illness and point to a potential cardiovascular health epidemic in this group (Bailey, Gerada, Lester, & Shiers, 2012). Physiological and emotional developmental changes that occur during adolescence and young adulthood impact on health and well-being broadly, and many modifiable risk factors for later life emerge or accelerate during this time (Australian Institute of Health and Welfare [AIHW], 2014), including smoking and alcohol consumption. "
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    ABSTRACT: Comorbid physical health conditions, commonly associated with mental illness, contribute to increased morbidity and reduced life expectancy. The trajectory to poorer health begins with the onset of mental illness. For young people with mental illness, health risk behaviours and poor physical health can progress to adulthood with long-term detrimental impacts. Using a cross-sectional survey design, self-reported health risk behaviours were gathered from 56 young (16–25 years)Australians who had been hospitalised for mental illness and taking psychotropic medication. Smoking, alcohol use, minimal physical activity, and lack of primary health care were evident. While these behaviours are typical of many young people, those with mental illness have substantially increased vulnerability to poor health and reduced life expectancy. Priority needs to be given to targeted health promotion strategies for young people with mental illness to modify their risky long-term health behaviours and improve morbidity and mortality outcomes. Nurses in mental health settings play a vital role in promoting young peoples’ well-being and preventing poorer physical health outcomes. Implementation of a cardiometabolic health nurse role in inpatient settings for young people with mental illness could facilitate prevention and early intervention for health risk behaviours.
    Issues in Mental Health Nursing 10/2015; 36(10):781-790. DOI:10.3109/01612840.2015.1036480
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    • "In addition, a recent and growing body of literature has identified the negative consequences of common psychotropic medications, resulting in further metabolic dysfunction and weight gain (Curtis et al. 2012; Teff et al. 2013). Modifiable risk factors, such as smoking, substance abuse, physical inactivity, and poor dietary habits, are known to further compound the poor physical health of mental health consumers (Curtis et al. 2012; Nihalani et al. 2011). "
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    ABSTRACT: The aim of the present study was to: (i) document the prevalence of risk factors for non-communicable diseases among mental health consumers (inpatients) with various diagnoses; and (ii) audit the frequency of waist circumference (WC) documentation before and after an intervention that involved a single nurse-education session, and change in assessment-form design. The study was undertaken in a private psychiatric hospital in Sydney, Australia. Twenty-five nurses participated in the educational intervention. File audits were performed prior to intervention delivery (n = 60), and 3 months' (n = 60), and 9 months' (n = 60) post-intervention. Files were randomly selected, and demographic (age, diagnosis) and risk factor (WC, body mass index (BMI), smoking status, blood pressure) data were extracted. WC was higher in this cohort compared to published general population means, and only 19% of patients had a BMI within the healthy range. In total, 37% of patients smoked, while 31% were hypertensive. At baseline, none of the audited files reported WC, which increased to 35 of the 60 (58%) files audited at the 3-month follow up. At the 9-month follow up, 25 of the 60 (42%) files audited reported a WC. In the 120 post-intervention files audited, only two patients refused measurement. These results illustrate the poor physical health of inpatients, and suggest that nurse-assessed metabolic monitoring can be enhanced with minimal training.
    International journal of mental health nursing 01/2014; 23(3). DOI:10.1111/inm.12057 · 1.95 Impact Factor
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    • "We have developed a clinical decision tool incorporating the current evidence to detect and assertively intervene in antipsychotic induced weight gain, with the aim of actively preserving cardiometabolic health (Curtis et al., 2011); article/1007767.html). "
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    ABSTRACT: There is uncertainty with regard to the appropriate use of metformin for the prevention and management of second-generation antipsychotic-induced weight gain and metabolic abnormalities. We aim to systematically review the primary literature and to provide recommendations with regard to the use of metformin in psychiatric populations prescribed second-generation antipsychotics. The authors undertook a literature search of Medline, EMBASE, and PsycINFO using the search terms; antipsychotic OR atypical antipsychotic AND weight AND metformin. Narrative review was undertaken without additional statistical analysis. The search provided 198 results from which 10 original research papers were identified: six randomized controlled trials and one open-label study for adults and two randomized controlled trials and one open-label study for children and adolescents. Four meta-analyses were also identified. We concluded that if weight gain occurs after second-generation antipsychotic initiation, despite lifestyle intervention, metformin should be considered. Further studies with adequate statistical power are required to determine the efficacy of metformin in those with chronic psychotic illness.
    International clinical psychopharmacology 03/2012; 27(2):69-75. DOI:10.1097/YIC.0b013e32834d0a5b · 2.46 Impact Factor
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