Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-24T07:02:30.343Z Has data issue: false hasContentIssue false
  • English
  • Français

Physical health in schizophrenia: a challenge for antipsychotic therapy

Published online by Cambridge University Press:  16 April 2020

A. Heald
A. Heald*
Affiliation:
Ward 7 Office, Leighton Hospital, Middlewich Road, Crewe, Cheshire CW1 4QJ, UK
*
Correspondence. Tel.: +44 (0)1270 612353. E-mail address: adrian.heald@manchester.ac.uk
Get access

Abstract

In the management of schizophrenia, mental health outcomes are the principal focus of treatment. The objective is to control the psychotic symptoms while minimising negative features of the illness, to achieve an overall improvement in the societal functioning of patients. Physical health is also important because if it is compromised, many of the benefits of improved mental health will be offset. Compared with the general population, schizophrenia patients are at increased risk of weight gain, abdominal obesity, diabetes, metabolic syndrome, and cardiovascular disease. These physical health problems can contribute to the decreased quality of life, lowered self-esteem and reduced life expectancy commonly reported in schizophrenia. For these reasons there is a pressing need to improve both the monitoring and the management of physical health in patients with schizophrenia as a part of their overall care. A consensus for metabolic monitoring of patients receiving treatment with antipsychotic drugs is available. However, the practicing clinician requires guidance about management of physical health in routine clinical practice. This should include recommendations for measurements that have strong predictive value about physical health risks yet are easy to make, and about the use of medications that have the least effect on physical health parameters. This article will review the gravity of the physical health risks facing schizophrenia patients.

Keywords

SchizophreniaPhysical healthAntipsychotic therapyHealth assessmentDiabetesCardiovascular risk
Type
Research Article
Information
European Psychiatry , Volume 25 , Issue S2: Physical health in patients with schizophrenia: current knowledge and practical recommendations , June 2010 , pp. S6 - S11
Copyright
Copyright © 2010 Elsevier Masson SAS

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alberti, K.G.Eckel, R.H.Grundy, S.M.Zimmet, P.Z.Cleeman, J.I.Donato, K.A., et al.Harmonizing the Metabolic Syndrome. A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640–1645CrossRefGoogle Scholar
Alberti, K.G.Zimmet, P.Shaw, J.The metabolic syndrome-a new worldwide definition. Lancet 2005; 366: 1059–1062CrossRefGoogle ScholarPubMed
Allison, D.B.Fontaine, K.R.Moonseong, H.Mentore, J.L.Cappelleri, J.C.Chandler, L.P., et al.The distribution of Body Mass Index among Individuals with and without Schizophrenia. J Clin Psychiatry 1999; 60: 215CrossRefGoogle ScholarPubMed
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27: 596–601CrossRefGoogle Scholar
Banerji, M.A.Lebowitz, J.Chaiken, R.L.Gordon, D.Kral, J.G.Lebowitz, B.D.Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects. Am J Physiol 2007; 273: E425Google Scholar
Brown, S.Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997; 171: 502–508CrossRefGoogle ScholarPubMed
Casey, D.E.Haupt, D.W.Newcomer, J.W.Henderson, D.C.Sernyak, M.J.Davidson, M., et al.Antipsychotic-induced weight gain and metabolic abnormalities: implications for increased mortality in patients with schizophrenia. J Clin Psychiatry 2004; 65(Suppl. 7): 4–18Google ScholarPubMed
De Hert, M.Dekker, J.M.Wood, D.Kahl, K.G.Moller, H.J.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). Eur Psychiatry 2009; 24: 412–424CrossRefGoogle Scholar
De Hert, M.Schreurs, V.Sweers, K.Van Eyck, D.Hanssens, L.Sinko, S., et al.Typical and atypical antipsychotics differentially affect longterm incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review. Schizophr Res 2008; 101: 295–303CrossRefGoogle Scholar
De Hert, M.van Winkel, R.Van Eyck, D.Hanssens, L.Wampers, M.Scheen, A., et al.Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study. Clin Pract Epidemol Ment Health 2006; 2: 14CrossRefGoogle ScholarPubMed
Dolder, C.R.Lacro, J.P.Jeste, D.V.Adherence to antipsychotic and nonpsychiatric medications in middle-aged and older patients with psychotic disorders. Psychosom Med 2003; 65: 156–162CrossRefGoogle ScholarPubMed
Expert Panel on Detection Evaluation And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285: 2486–2497CrossRefGoogle Scholar
Faulkner, G.Cohn, T.Remington, G.Irving, H.Body mass index, waist circumference and quality of life in individuals with schizophrenia. Schizophr Res 2007; 90: 174–178CrossRefGoogle ScholarPubMed
Field, A.E.Coakley, E.H.Must, A.Spadano, J.L.Laird, N.Dietz, W.H., et al.Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001; 161: 1581–1586CrossRefGoogle ScholarPubMed
Goff, D.C.Sullivan, L.M.McEvoy, J.P.Meyer, J.M.Nasrallah, H.A.Daumit, G.L., et al.A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophr Res 2005; 80: 45–53CrossRefGoogle ScholarPubMed
Goldman, L.S.Medical illness in patients with schizophrenia. J Clin Psychiatry 1999; 60(Suppl. 21): 10–15Google ScholarPubMed
Grundy, S.M.Cleeman, J.I.Daniels, S.R.Donato, K.A.Eckel, R.H.Franklin, B.A., et al.Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112: 2735–2752CrossRefGoogle ScholarPubMed
Haddad, P.M.Wieck, A.Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management. Drugs 2004; 64: 2291–2314CrossRefGoogle ScholarPubMed
Herrán, A.de Santiago, A.Sandoya, M.Fernández, M.J.Diez-Manrique, J.F.Vázquez-Barquero, J.L.Determinants of smoking behaviour in outpatients with schizophrenia. Schizophr Res 2000; 41: 373–381CrossRefGoogle ScholarPubMed
Holt, R.I.Bushe, C.Citrome, L.Diabetes and schizophrenia 2005: are we any closer to understanding the link? J Psychopharmacol 2005; 19(6 Suppl.): 56–65CrossRefGoogle ScholarPubMed
Huxley, R.Barzi, F.Woodward, M.Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006; 332: 73–78CrossRefGoogle ScholarPubMed
Isomaa, B.Almgren, P.Tuomi, T.Forsen, B.Lahti, K.Nissen, M., et al.Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683–689CrossRefGoogle ScholarPubMed
Kahn, R.Metabolic syndrome--what is the clinical usefulness? Lancet 2008; 371: 1892–1893CrossRefGoogle ScholarPubMed
Kahn, R.Buse, J.Ferrannini, E.Stern, M.The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005; 28: 2289–2304CrossRefGoogle Scholar
Kato, M.M.Currier, M.B.Gomez, C.M.Hall, L.Gonzalez-Blanco, M.Prevalence of metabolic syndrome in Hispanic and non-Hispanic patients with schizophrenia. Prim Care Companion J Clin Psychiatry 2004; 6: 74–77CrossRefGoogle ScholarPubMed
Lawrence, D.M.Holman, C.D.Jablensky, A.V.Hobbs, M.S.Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980-1998. Br J Psychiatry 2003; 182: 31–36CrossRefGoogle ScholarPubMed
Maguire, G.A.Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences. J Clin Psychiatry 2002; 63(Suppl. 4): 56–62Google ScholarPubMed
McEvoy, J.P.Meyer, J.M.Goff, D.C.Nasrallah, H.A.Davis, S.M.Sullivan, L., et al.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. Schizophr Res 2005; 80: 19–32CrossRefGoogle ScholarPubMed
Montejo, A.L.The need for routine physical healthcare in schizophrenia. Eur Psychiatry 2010; 25: S3–S5CrossRefGoogle Scholar
Mozaffarian, D.Kamineni, A.Prineas, R.J.Siscovick, D.S.Metabolic syndrome and mortality in older adults: the Cardiovascular Health Study. Arch Intern Med 2008; 168: 969–978CrossRefGoogle ScholarPubMed
Mulnier, H.E.Seaman, H.E.Raleigh, V.S.Soedamah-Muthu, S.S.Colhoun, H.M.Mortality in people with Type 2 diabetes in the UK. Diabet Med 2006; 23: 516–521CrossRefGoogle ScholarPubMed
Nasrallah, H.A.Meyer, J.M.Goff, D.C.McEvoy, J.P.Davis, S.M.Stroup, T.S., et al.Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res 2006; 86: 15–22CrossRefGoogle ScholarPubMed
Newcomer, J.W.Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs 2005; 19(Suppl. 1): 1–93CrossRefGoogle ScholarPubMed
Osborn, D.P.Levy, G.Nazareth, I.Petersen, I.Islam, A.King, M.B.Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's General Practice Rsearch Database. Arch Gen Psychiatry 2007; 64: 242–249CrossRefGoogle ScholarPubMed
Osby, U.Correia, N.Brandt, L.Ekbom, A.Sparen, P.Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000; 45: 21–28CrossRefGoogle ScholarPubMed
Sattar, N.McConnachie, A.Shaper, A.G.Blauw, G.J.Buckley, B.M.de Craen, A.J., et al.Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet 2008; 371: 1927–1935CrossRefGoogle ScholarPubMed
Smith, N.L.Barzilay, J.I.Kronmal, R.Lumley, T.Enquobahrie, D.Psaty, B.M.New-onset diabetes and risk of all-cause and cardiovascular mortality. Diabet Med 2006; 29: 2012–2017Google ScholarPubMed
Subramaniam, M.Chong, S.A.Pek, E.Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia. Can J Psychiatry 2003; 48: 345–347CrossRefGoogle ScholarPubMed
Turrone, P.Kapur, S.Seeman, M.V.Flint, A.J.Elevation of prolactin levels by atypical antipsychotics. Am J Psychiatry 2002; 159: 133–135CrossRefGoogle ScholarPubMed
Ucok, A.Incesu, C.Aker, T.Erkoc, S.Sexual dysfunction in patients with schizophrenia on antipsychotic medication. Eur Psychiatry 2007; 22: 328–333CrossRefGoogle ScholarPubMed
Ward, A.Ishak, K.Proskorovsky, I.Caro, J.Compliance with refilling prescriptions for atypical antipsychotic agents and its association with the risks for hospitalization, suicide, and death in patients with schizophrenia in Quebec and Saskatchewan: a retrospective database study. Clin Ther 2006; 28: 1912–1921CrossRefGoogle ScholarPubMed
Wilson, P.W.D’Agostino, R.B.Levy, D.Belanger, A.M.Silbershatz, H.Kannel, W.B.Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837–1847CrossRefGoogle ScholarPubMed
Yusuf, S.Hawken, S.Ounpuu, S.Bautista, L.Franzosi, M.G.Commerford, P., et al.Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640–1649CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.