Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care

World Psychiatry, Год журнала: 2011, Номер 10(1), С. 52 - 77

Опубликована: Фев. 1, 2011

The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality mainly due physical illness. We report prevalence rates different illnesses as well important individual lifestyle choices, side effects psychotropic treatment and disparities in health care access, utilization provision that contribute these poor outcomes. searched MEDLINE (1966 - August 2010) combining MeSH terms schizophrenia, bipolar disorder major depressive disease categories select pertinent reviews additional relevant studies through cross-referencing identify figures factors contributing morbidity rates. Nutritional metabolic diseases, cardiovascular viral respiratory tract musculoskeletal sexual dysfunction, pregnancy complications, stomatognathic possibly obesity-related cancers are, population, more prevalent among SMI. It seems specific account for much increased risk most diseases. Moreover, there sufficient evidence SMI are less likely receive standard levels Lifestyle factors, relatively easy measure, barely considered screening; baseline testing numerous parameters insufficiently performed. Besides modifiable medications, access quality remains be improved individuals

Язык: Английский

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A Systematic Review of Mortality in Schizophrenia

Archives of General Psychiatry, Год журнала: 2007, Номер 64(10), С. 1123 - 1123

Опубликована: Окт. 1, 2007

Context

Despite improvements in mental health services recent decades, it is unclear whether the risk of mortality schizophrenia has changed over time.

Objective

To explore distribution standardized ratios (SMRs) for people with schizophrenia.

Data Sources

Broad search terms were used MEDLINE, PsychINFO, Web Science, and Google Scholar to identify all studies that investigated schizophrenia, published between January 1, 1980, 31, 2006. References also identified from review articles, reference lists, communication authors.

Study Selection

Population-based reported primary data on deaths Extraction Operationalized criteria extract key study features data. Synthesis We examined SMRs pooled selected estimates using random-effects meta-analysis. 37 articles drawn 25 different nations. The median SMR persons all-cause was 2.58 (10%-90% quantile, 1.18-5.76), a corresponding 2.50 (95% confidence interval, 2.18-2.43). No sex difference detected. Suicide associated highest (12.86); however, most major causes-of-death categories found be elevated have increased during decades (P = .03).

Conclusions

With respect mortality, substantial gap exists general community. This differential worsened decades. In light potential second-generation antipsychotic medications further adversely influence rates come, optimizing warrants urgent attention.

Язык: Английский

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Second-Generation (Atypical) Antipsychotics and Metabolic Effects

CNS Drugs, Год журнала: 2005, Номер 19(Supplement 1), С. 1???93 - 1???93

Опубликована: Янв. 1, 2005

Язык: Английский

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Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III

Schizophrenia Research, Год журнала: 2005, Номер 80(1), С. 19 - 32

Опубликована: Авг. 31, 2005

Язык: Английский

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Metabolic and cardiovascular adverse effects associated with antipsychotic drugs

Nature Reviews Endocrinology, Год журнала: 2011, Номер 8(2), С. 114 - 126

Опубликована: Окт. 18, 2011

Язык: Английский

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Schizophrenia, “just the facts” 4. Clinical features and conceptualization

Schizophrenia Research, Год журнала: 2009, Номер 110(1-3), С. 1 - 23

Опубликована: Март 30, 2009

Язык: Английский

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Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC)

European Psychiatry, Год журнала: 2009, Номер 24(6), С. 412 - 424

Опубликована: Авг. 14, 2009

People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated schizophrenia disorder is attributed in part an increased risk of modifiable coronary heart disease factors; obesity, smoking, diabetes, hypertension dyslipidaemia. Antipsychotic medication possibly other psychotropic like antidepressants can induce weight gain worsen metabolic factors. Patients may limited access healthcare less opportunity for screening prevention than would be expected a non-psychiatric European Psychiatric Association (EPA), supported by Study Diabetes (EASD) Society Cardiology (ESC) published this statement aim improving care patients suffering from illness. intention initiate cooperation shared between different professionals increase awareness psychiatrists primary physicians caring illness screen treat factors diabetes.

Язык: Английский

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Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

World Psychiatry, Год журнала: 2011, Номер 10(2), С. 138 - 151

Опубликована: Июнь 1, 2011

As outlined in the first part of this bi-partite publication 1, individuals with severe mental illness (SMI) are at an increased risk for a large number physical disorders that require clinical attention. People SMI entitled to same standards care as rest population. However, rates undiagnosed and untreated medical illnesses higher individuals, compared general Despite fact morbidity mortality patients largely due modifiable lifestyle factors there is sufficient evidence disparities not only health access utilization, but also provision, contribute these poor outcomes 2,3. According one recent study, people psychotic disorders, bipolar disorder, or major depressive disorder have greatly odds reporting difficulties accessing (odds ratios, OR=2.5–7.0) 4. Although parity provision should be conceived basic human right, confluence patient, provider, treatment system has created situation which quality problematic 5. Table 1 summarizes barriers recognition management somatic patients. In many cases, patients' contact service through team. Moreover, because their SMI, less capable than other interpreting signs, well solving problems caring themselves, places responsibility on workers fore front 6. Two consensus conferences called providers take 7,8. despite data suggesting sensitization psychiatrists expand tasks include assessments both can improved by guidelines 9, still consider primary or, even, sole function provide terms psychiatric symptom control reluctant monitor related patient his/her illness, and/or clinician treatment, reintegration services, ultimate goal providing optimal services vulnerable population, seems represent most important challenges today 7,10. broader picture: 37% 195 countries world do even specified budget health, 25% (of 101 reported budget) spend 1% total 11. some parts world, resources poorer. Africa Western Pacific Regions, policy was found present half 12. developing developed countries, stigmatization, discrimination, erroneous beliefs negative attitudes associated will eliminated achieve provision. Due differences between regions (e.g., level economic development, budgeting care, availability personnel, etc.), majority actions adapted local needs circumstances 7. The excess persons 1. Therefore, monitoring routine psychiatrist. Furthermore, address problem suboptimal changes need made delivery 48, wherein psychiatrist, once again, play pivotal role. Physical checks focus 49,50,51: - weight gain obesity (body mass index, BMI; waist circumference, WC); blood pressure; dietary intake; activity exercise; use tobacco alcohol substances; fasting levels glucose; lipids, especially triglycerides high-density lipoprotein (HDL)-cholesterol; prolactin (if indicated reproductive sexual symptoms); cardiovascular disease (CVD) electrocardiographic (ECG) parameters; dental health; liver tests, count, thyroid hormone, electrolytes (periodically, indicated). Many tests simple, easy perform inexpensive 6,52,53,54, therefore can/should implemented systems countries. several simple measurements body pressure) routinely done doctors. Screening assessment begin patient's personal family history, covering 40: diabetes mellitus (DM), hypertension, CVD (myocardial infarction cerebrovascular accident, including age onset), smoking, diet, activity. Secondly, individual components metabolic syndrome (MetS) (see 1) critical predicting CVD, DM, cancer diseases, these, non-metabolic parameters, checked baseline measured regularly thereafter 46,51. Concerning remember drug-naïve, first-episode patients, children adolescents side effects medications 55,56. Higher values visceral fat distribution, laboratory impaired glucose lipid metabolism, been, although consistently, 57. Likewise, young drug-naïve non-Caucasian ethnicity history more likely develop Psychiatrists should, regardless medication prescribed, chart BMI WC every visit, encourage own 58. useful measurement BMI. Prospective tolerance revealed central adiposity, having strong correlation insulin resistance 59, better predicted future type 2 DM 60. stronger indicator systolic pressure, HDL-cholesterol, 61, been proposed best single measure identify high MetS 52. It tool assess likelihood resistance: <100 cm excluded 98% males 94% females 61. This easily tape measure. International Diabetes Federation (IDF) definition provides sex- race-specific criteria defining elevated obesity, thus adapting criterion make it applicable populations. multiple studies rarely 62,63,64. plasma profile assessed, if normal. seem cluster, presence component often suggests others. High pressure missed 65. cost measuring low, hypertension relevant factor, can/ought assessed routinely, visit. Hypertension defined $130 mm Hg diastolic $85 66. diagnosis requires least two separate, independent fall within range Individuals 120 130 80 85 considered pre-hypertensive modifications prevent heart 67. A collected all before starting antipsychotic (AP) finger prick carried out baseline, 6 12 weeks capture early cases hyperglycemia then, minimum, yearly. Formal screening then when necessary 68. Ideally, conducted state, sensitive detection abnormalities. prove achieve. where non-fasting, preferable conduct random test (and/or hemoglobin A1C test), rather miss opportunity screen An abnormal value (fasting ≥126 mg/dl ≥6.5%) 69 possibility DM. Fasting 100 125 (or 5.7–6.4%) indicative pre-diabetes prompt closer follow-up. false positive results repeated glucose. If abnormality confirmed, frequency 4 times year speed rise. >6.4%, second confirms abnormality, lead consultation internist provider further and, possibly, treatment. Importantly, reflects mean during past 3 months. excellent outcome, probably enough detect hyperglycaemia its stages 70. Patients who significant (family ≥25, above values, gestational diabetes, minority ethnicity) monitored time points (baseline, week 12), they frequently (approximately 3–6 months). gaining 7% frequently, example, months Because mortality, special attention given diabetic ketoacidosis (DKA). DKA signs symptoms quickly, sometimes 24 hours. One may notice: polyuria polydipsia, nausea vomiting, abdominal pain, appetite, unintended loss, fatigue, Kussmaul respirations (a pattern deep breathing hyperventilation response acidosis), fruity-scented breath, somnolence confusion. presentation varies substantially depending severity episode mild moderately ill describe vague lethargy, headache). polydipsia building More specific DKA, detected include: >250 mg/dL, pH <7.3 moderate degree ketonemia ketonuria 71,72,73,74. Lipid parameters (especially HDL-cholesterol) months, 12-monthly thereafter. frequent unnecessary, unless case values. Abnormal cholesterol >190 without >175 low-density (LDL)-cholesterol >115 >100 mg/dl, respectively lack feasible settings calculated from age, sex, absence smoking habit, cholesterol, ratio HDL-cholesterol reference published guidelines, protocols online calculators. These relatively accessible 54. setting, difficult obtain ECG rapidly acute settings. economically obtaining problematic. whatever psychotropic psychiatrist intending prescribe, asked about risks, such cardiac death (i.e, <50 years <55 females), murmur, previous prescription anti-hypertensives, he/she ever had syncope 51. Nevertheless, requirement deserves serious consideration. We propose seen desired parameter order overall status. rule, we recommend prior initiation medication. Thereafter, advice cardiologist, repeated. arrhythmias, i.e., those death, tachycardia rest, irregular beats fainting spells, particularly upon exertion. possible, value, baseline. too expensive, abnormalities reported. Yet, directly monitored. Reproductive triggering amenorrhea oligomenorrhea <9 periods per year), galactorrhea, gynecomastia males, breast tenderness pain females. Sexual dysfunction new coincided dose change, decreased libido, erectile ejaculatory dysfunction, arousal orgasm. increasing known prolactin-elevating compounds. aware ranges differ sites 75,76, laboratories normal set 20 ng/ml (424 mIU/mL) men 25 (530 mIU/L) women 77. complicating factor macroprolactin, essentially biologically inactive, falsely assays 78. Conservative estimates suggest macroprolactin leads misdiagnosis 10% instances biochemical hyperprolactinemia 79. significantly raised, estimated monomeric instead just "macroprolactin positive" avoid unnecessary investigations. With below 200 mostly, commonly observed. To date, physiological relevance unknown, hypogonadism (i.e., state markedly reduced sex hormone production) result, osteoporosis fracture risk. much clear. What certain any change elevating quetiapine, aripiprazole refractory clozapine). Magnetic resonance imaging (MRI) sella turcica rule prolactinoma ordered after reasons elevation chronic renal failure assessing creatinine, hypothyroidism stimulating pregnancy oral contraception), decrease lower agent, lateral visual deficits observed, raising suspicion 80. currently clinicians important, scrutinized way 81,82. Risk effects) 83. programs accepted variety Contrary belief, motivate assessments, keen getting discussing evaluations 53,54. using algorithm 84, form 65,86 simpler option complex detailed previously published. Although, over years, national international groups 58,84,87,88,89,90,91,92,93,94,95, 62,64,96,97. Follow-up appropriate intervals 98 (Table 2). recorded charts showing During initial phases weekly rapidly. Waterreus Laugharne 84 advocate (to high-risk ensure parameters), Other annually, adverse overweight ethnicity, etc.). hypertensive (≥130/85 Hg), =100–125 mg/dL =5.7–6.4%) >6.4%), marked dyslipidemia (total >350 mg/dL; LDL-cholesterol >160 >300 mg/dL), referred treat conditions, healthy guidance behavioural adjustment switching cardiometabolic conditions adequately 17,99. Many, all, either unaware possess knowledge skills required changes. Psychiatrists, physicians, nurses members multidisciplinary team help educate lifestyle, diet exercise, effective interventions 57,100. caregivers, taught lifestyles receive psychoeducational packages facilitate them. Psychoeducation does administered specialist nutritionist), nor training, staff clinic. Lifestyle obtained already available mainstream provided feedback support 17 must tailored meet 14. Non-pharmacological interventions, incorporating modifications, demonstrated promise preventing schizophrenia 94,95,96,97,98,99,100,101,102,103. impact one's life style changes, considerable 3). regular quitting key lowering prevalence factors. succeed, medication, statins, anti-hypertensive therapy antidiabetic agents, indicated. drugs prescribed managed population generally tolerated 109,110. pharmacologic treatments added reduce antipsychotic-related tried. exists metformin (500 1000 mg bid meals) topiramate (50–200 divided doses) 111. know 46. 111, refined sugar 112, fiber 25, fruits vegetables 113. nutrition education beneficial advised juices soft drinks containing artificial sweeteners, calorie, fat, nutritionally food, fast food unhealthy snacks. importance consuming alternatives, fresh fruit vegetables, fish, lean meats balanced way, stressed whenever possible. educating (as caregivers) recommended, understand gradual. Most experience rapid loss gradual behaviour return weight. Losing hastily increases gallstones. Further, toxins stored tissue release quickly Changes composition substantial effects. Weight health-related benefits particular reduction serum concentrations, increase concentrations A1c among nutrition, become 98. involve educational psychosocial issues wellness, comorbidities programs, "The Healthy Living" program, "Small Changes" strategy "Solutions Wellness" program shown 114,115,116,117,118,119. gives examples improve SMI. inactivity theoretically addressed modified 100. sedentary 120. Only 25.7% minimum public recommendation 150 min moderate-intensity 121,122. American College Sports Medicine Heart Association, 250 modest gain. Greater amounts (>250 week) clinically 108. status loss. There counselling reducing improving 123. obese, exercise accompanied proper For walks hour day, calories burned. While energy expenditure result strenuous activities, jogging, Considering facts, engage 30 minutes vigorous (at brisk walk) days meta-analysis worldwide schizophrenic heavy nicotine dependence, them start 124. Up 85% die tobacco-related 48,125. Cessation approximately 50% coronary 104, 75% high/very 10-year events 126. strongly encouraged stop smoking. cessation implications taking clozapine olanzapine. Abrupt potentially toxicity clozapine, while olanzapine significantly. Cormac et al 127 percentage ≥1000 µg/l 4.2% 41.7% six month period following ban reductions. closely adjustments dosage, necessary, 127. short-term prospective adults quit experienced incident peaked (hazard ratio, HR=1.91) observable quitting. partially mediated gain: withdrawal appetite caloric intake. countermeasures replacement therapy), smokers 128. Treating dependence emerging 129,130,131,132. work appear equally treating stable worsen 133. Finally, hospitals express concerns adopting smoke-free would hospital's milieu, necessarily 134. professionals advise users quit, assist plan, arrange follow-up service, offer counselling, pharmacological Target 130/85 mmHg recommended. stopping salt intake, mildly Recently updated European stress choosing agents suited 86,135. Oral advice, needs. Preventive programmes different diagnoses, illness. issues, namely dry mouth carbohydrate craving. Advice sugars free lubrication relieve essential drugs. habits. training identification hygiene techniques, Above encourageme

Язык: Английский

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Metabolic syndrome in people with schizophrenia: a review

World Psychiatry, Год журнала: 2009, Номер 8(1), С. 15 - 22

Опубликована: Фев. 1, 2009

Metabolic syndrome and other cardiovascular risk factors are highly prevalent in people with schizophrenia. Patients at for premature mortality overall have limited access to physical health care. In part these cardio-metabolic attributable unhealthy lifestyle, including poor diet sedentary behaviour. But over recent years it has become apparent that antipsychotic agents can a negative impact on some of the modifiable factors. The psychiatrist needs be aware potential metabolic side effects medication include them risk/benefit assessment when choosing specific antipsychotic. He should also responsible implementation necessary screening assessments referral treatment any illness. Multidisciplinary psychiatric medical conditions is needed. somatic treatments offered severe enduring mental illness par general care non-psychiatrically ill population.

Язык: Английский

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Relative Risk of Cardiovascular and Cancer Mortality in People With Severe Mental Illness From the United Kingdom's General Practice Research Database

Archives of General Psychiatry, Год журнала: 2007, Номер 64(2), С. 242 - 242

Опубликована: Фев. 1, 2007

People with severe mental illness (SMI) appear to have an elevated risk of death from cardiovascular disease, but results regarding cancer mortality are conflicting.To estimate this excess and the contribution antipsychotic medication, smoking, social deprivation.Retrospective cohort study.United Kingdom's General Practice Research Database. Patients Two cohorts were compared: people SMI diagnoses without such diagnoses. Main Outcome Measure Mortality rates for coronary heart disease (CHD), stroke, 7 most common cancers in United Kingdom.A total 46 136 300 426 selected study. Hazard ratios (HRs) CHD compared controls 3.22 (95% confidence interval [CI], 1.99-5.21) 18 through 49 years old, 1.86 CI, 1.63-2.12) those 50 75 1.05 0.92-1.19) older than years. For stroke deaths, HRs 2.53 0.99-6.47) younger years, 1.89 1.50-2.38) 1.34 1.17-1.54) The only significant result deaths was unadjusted HR respiratory tumors 1.32 1.04-1.68) which lost statistical significance after controlling smoking deprivation. Increased occurred irrespective sex, diagnosis, or prescription medication during follow-up. However, a higher prescribed dose antipsychotics predicted greater stroke.This large community sample demonstrates that increased is not wholly explained by deprivation scores. Rates nonrespiratory raised. Further research required concerning prevention mortality, including assessment, monitoring attention diet exercise.

Язык: Английский

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