Clinicians' recognition of the metabolic adverse effects of antipsychotic medications
ABSTRACT There is a growing concern regarding the propensity of second generation antipsychotics (SGAs) to induce weight gain and metabolic adverse effects. Recent consensus guidelines have recommended assessment and monitoring procedures to appropriately detect and manage these adverse effects. This study addresses the appreciation and readiness of clinicians to implement management guidelines for these adverse effects. Respondents indicated awareness of the risks of treatment with SGAs. The extent of monitoring for metabolic adverse effects was low and inconsistent across measures and in frequency of evaluation. Ongoing efforts are needed to support and encourage change in clinician practice.
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ABSTRACT: Mortality rates in patients with schizophrenia are double compared with the general population, with cardiovascular disease causing 50% of the excess. Lowering low-density lipoprotein cholesterol is recognized as a primary target for the prevention of cardiovascular mortality. The effects of lipid-lowering treatment were evaluated in patients with schizophrenia. Forty-six patients with schizophrenia and with severe dyslipidaemia were identified. All were treated with antipsychotics. Patients were screened for cardiovascular risk factors and examined at baseline when statin therapy was initiated. The effects of lipid-lowering medication on lipid profile, glucose homeostasis and components of metabolic syndrome were evaluated at 3 months follow-up. After 3 months of statin therapy, a significant decrease in triglycerides, total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and, in associated ratios, low-density lipoprotein/high-density lipoprotein, cholesterol/high-density lipoprotein was observed. No significant changes occurred in high-density lipoprotein cholesterol, body mass index, waist circumference or glucose homeostasis. The only component of metabolic syndrome affected by statin therapy has been the serum triglyceride level. Statins proved effective in the management of dyslipidaemia in patients with schizophrenia treated with antipsychotics. More complex treatment may be required for associated metabolic disturbances.International Clinical Psychopharmacology 02/2007; 22(1):43-9. DOI:10.1097/YIC.0b013e3280113d3b
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ABSTRACT: Persons diagnosed with schizophrenia have higher morbidity and mortality rates from cardiovascular disease, yet often have limited access to appropriate primary care screening or treatment. Metabolic disorders such as diabetes, hyperlipidemia and hypertension are highly prevalent in populations with schizophrenia, exceeding 50% in some studies; however, there have been few published studies on treatment rates among schizophrenia patients screened for these disorders. Using the baseline data from subjects (N=1460) recruited into the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study, we examined the point prevalence of diabetes, hyperlipidemia and hypertension treatment at the time of enrollment for the entire cohort and those with fasting laboratory values obtained 8 or more hours since last meal. Rates of non-treatment ranged from 30.2% for diabetes, to 62.4% for hypertension, and 88.0% for dyslipidemia. Nonwhite men were more likely to be treated for DM and dyslipidemia than nonwhite women. These data indicate the high likelihood that metabolic disorders are untreated in patients with schizophrenia, with particularly high rates of non-treatment for hypertension and dyslipidemia. Nonwhite women may be especially vulnerable to undertreatment of dyslipidemia and diabetes compared to nonwhite men. The findings here support the need for increased attention to basic monitoring and treatment of cardiovascular risk factors in this vulnerable and often underserved psychiatric population.Schizophrenia Research 10/2006; 86(1-3):15-22. DOI:10.1016/j.schres.2006.06.026
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ABSTRACT: Developing effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. This article sets out the general professional and Irish statutory obligations to provide physical health monitoring services for individuals with serious mental illness. Review and summary statements are provided in relation to the currently available guidelines on physical health monitoring. Developing effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. Individuals with serious mental illness (SMI – defined as any DSM [Diagnostic and Statistical Manual] mental disorder leading to substantial functional impairment) have higher than expected rates of physical morbidity and mortality in comparison with members of the general popula-tion. Mortality rates are increased across all psychiatric diagnostic categories and treatment settings, 1-5 although patients attending specialist psychiatric services appear to be at particular risk. 1 Excess morbidity and mortality has been reported in relation to cardiovascular, respiratory, endocrine, neurological, gastrointestinal, infective, and malignant aetiol-ogy. 1-4,6,7 Poor physical health is often evident from an early age and contributes to the proven 10%-20% reduction in life expectancy associated with SMI. 5,8 The relationship between mental disorder and poor physi-cal health is complex and a number of factors are likely to exert influence. Most individuals with SMI live relatively unhealthy lifestyles, with evidence suggesting that they smoke more, 9,10 have poorer diets, 10,11 are less physically active, 12 and are more likely to abuse alcohol or drugs 6,7 than population comparators. A greater inherent predisposition to develop metabolic abnormalities 13 coupled with potential metabolic adverse effects of antipsychotic drug treatments 14 may negatively influence physical health. Other adverse drug effects, including those on cardiovascular, endocrine, sexual and neurological health, are also of concern. 15 Individuals with SMI frequently have unidentified or untreated physical disor-ders, 16 are less likely to be aware of or report previously diagnosed medical conditions, 17 and have low compliance rates with medical treatment regimens. 18-20 Studies of healthcare utilisation have reported both higher and lower rates of service use, reflecting the study method-ologies employed. 21-23 Although service use varies according to psychiatric diagnosis and treatment settings, 21,22 those with SMI may be less likely to benefit from certain screening inves-tigations or preventive health programmes and more likely to receive care from accident and emergency departments. 21,23 In addition, a number of studies have highlighted disparities in the level of investigation and quality of treatment provided for physical disorders in individuals with SMI versus compara-tor patients. 24-27 Unsurprisingly, psychiatric and medical co-morbidity is associated with both poorer physical and mental health outcomes. 28-30 Cognisant of the importance of physical health monitoring for individuals with SMI, we set about planning a compre-hensive integrated service for patients attending Navan general adult psychiatric services. In terms of treatment setting, our community-based multidisciplinary team provides psychiatric outpatient and inpatient services to an urban catchment area population of 43,608 (Census 2006). Early development phases included a review of relevant back-ground information and currently available monitoring guidelines, followed by an audit of local practice and resources to document any service shortfalls. Subsequently, specific recommendations for action were published. We have reproduced some of our findings below, in the hope that service providers elsewhere might benefit from our exploratory work.