Prevention of Metabolic Syndrome in Serious Mental Illness
Section snippets
What is the metabolic syndrome?
The term metabolic syndrome was coined to describe a constellation of risk factors (central obesity, insulin resistance, raised blood pressure, and abnormal lipid profile) that were thought to be highly predictive of increased risk for heart disease, especially coronary heart disease.16 Current criteria for metabolic syndrome are summarized in Table 1. Recent meta-analyses confirm that persons with metabolic syndrome have almost double the risk of incident heart disease and coronary artery
Metabolic syndrome and obesity in serious mental illness
There has been a marked increase in overweight and obesity in the past 25 years, with the prevalence of obesity among all adults rising from 13% to 32% for both genders, and among all racial/ethnic and age groups.22 Obese individuals have an increased risk of several adverse health outcomes, notably hypertension, diabetes, CVD, arthritis, disability, and mortality.23 Obesity is an independent risk factor for CVD24 and the degree of obesity correlates with CVD risk.25
Exceptionally high rates of
Lifestyle management to prevent weigh gain and reduce weight
The foundation of risk reduction in both heart disease and diabetes lies in changing lifestyle, specifically eating and exercise, with the purpose of maintaining a healthy weight (preventing or treating obesity) and increasing physical activity and fitness. Guidelines for weight management were proposed by the National Heart, Lung and Blood Institute (NHLBI) in 1998, as an aid to reduce and postpone the incidence of heart disease. The Canadian Cardiovascular Society and Guidelines29 and the
Medication choice to reduce the risk of developing metabolic syndrome
Choice of antipsychotic medication may provide one of the rare opportunities for primary prevention in psychiatry. It is well established that the risk of weight gain and worsening of other metabolic parameters, such as dyslipidemia, varies between various antipsychotic agents.63 For example, data from the registration trials show that the risk for clinically significant weight gain (using >7% gain more than baseline as the cutoff) was about 10 times greater when comparing olanzapine with
Switching antipsychotic medication
Patients who experience weight gain in the course of treatment present opportunities for secondary prevention of metabolic syndrome. Because there are well-established differences in the weight gain liability of the different antipsychotics, patients who gain weight on one of the agents known to be associated with a high risk of weight gain might be candidates for a switch to an agent with a lower risk. Several recent studies have indeed shown that a significant proportion of patients might
Inflammation in metabolic syndrome
Because antipsychotic-induced weight gain in patients with schizophrenia may preferentially manifest as an increase in central body fat content rather than muscle mass or intercellular water,72, 73 this increased central adiposity renders patients with schizophrenia especially prone to metabolic adverse events.74 This is because the accumulation of excess fat in central adipose tissue is often accompanied by a chronic subacute state of inflammation, shown by changes in both inflammatory cells
Metabolic monitoring
As the prescribers of most psychotropic medications that may initiate or accelerate the development of metabolic syndrome, psychiatrists have been urged or, in some situations, mandated to monitor adverse metabolic changes their in patients. An influential recommendation appeared recently from a consensus panel convened by the American Psychiatric Association, the American Diabetes Association, the American Association of Clinical Endocrinologists, and North American Association for the Study
Treatment of components of the metabolic syndrome
When metabolic syndrome is present, or when any one of the risk factors appears, treatment to reduce or normalize the level of the risk factor is the obvious medical response. Primary goals in the clinical management of individuals who have developed the metabolic syndrome are to reduce the risks for clinical atherosclerotic disease and diabetes. First-line therapy should be directed toward the major risk factors: LDL-C, hypertension, and diabetes. Prevention of type 2 diabetes mellitus is
Integration of psychiatric and nonpsychiatric medical care
Psychiatrists may accept the responsibility for monitoring the presence or appearance of hypertension, dyslipidemia, or insulin resistance, but, at the present time, they are not likely to undertake to treat these conditions, nor would this be the best care for the patient. The data available show that patients with severe mental illnesses typically receive lower quality primary medical care and have worse outcomes than those without mental illness,95 that survival after a myocardial infarction
Summary
The metabolic syndrome is highly prevalent in schizophrenia and other serious mental illnesses, and represents a constellation of risk factors for cardiovascular disease and type 2 diabetes mellitus. Genetic factors, treatment with antipsychotic medication, socioeconomic status, and lifestyle likely interact to account for the high risk of metabolic syndrome, diabetes, heart disease, and premature mortality in people with serious mental illness. Although some newer medications do seem to be
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Metabolic syndrome and bipolar affective disorder: A review of the literature
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This work was partially supported by a Canadian Institutes of Health Research (CIHR) Tier 1 Canada Research Chair grant to Dr Ganguli, and a 2008 Young Investigator Award to Dr Martin Strassnig, from the National Alliance for Research in Schizophrenia and Depression (NARSAD).