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, Oct 10, 2015
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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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    ABSTRACT: Treatment of HIV infection with highly active antiretroviral therapy (HAART) confers survival and quality of life benefits. However, these significant benefits are at the cost of metabolic complications with associated increased risk of type 2 diabetes and cardiovascular disease. These chronic diseases add complexity to the standards of care in HIV infection and much remains unknown about the natural histories of diabetes and hyperlipidemia in this setting. This review examines recent research findings in diabetes and hyperlipidemia in HIV infection, juxtaposed on our prior understanding of these diseases. It also reviews the current evidence base and clinical guidelines for diabetes and lipid management and cardiometabolic prevention in HIV-infected HAART recipients.
    Current HIV/AIDS Reports 07/2012; 9(3):206-17. DOI:10.1007/s11904-012-0124-x · 3.80 Impact Factor
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