Patients with severe psychiatric illness at higher heart disease risk

November 14th, 2007 - 2:22 am ICT by admin  
The study relied on data from a national study of 1,500 patients with chronic schizophrenia who participated in the National Institute of Mental Health-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.

John W. Newcomer, M.D., professor of psychiatry, of psychology and of medicine and medical director of the Center for Clinical Studies at Washington University, said that those with such illnesses lose 25 to 30 years of life expectancy compared to the general population.

“This is really a double hit. Not only are these patients dealing with the serious burden that accompanies their psychiatric disorder, but they also have an increased risk and an increased burden from major medical conditions like diabetes, heart disease and stroke. Ultimately, it is the unrecognised risk factors and the under-diagnosed and under-treated conditions that significantly shorten the lifespan,” Newcomer said.

He said that several factors conspire to elevate risk including reduced access to appropriate medical care.

Major mental disorders significantly impair a person’s ability to work and learn, so patients tend to have lower incomes and poorer dietary habits, often relying instead on fast food.

In addition, patients with serious psychiatric illness are much more likely to smoke (between 50 percent and 80 percent smoke cigarettes) and although the severely mentally ill make up only between 5 percent and 10 percent of the population, they consume a disproportionate amount of cigarettes.

Many psychiatric medications also tend to contribute to weight gain, in part by making people less active and sometimes by stimulating appetite, and weight gain can be a prominent side effect of some antipsychotic drugs in particular.

He also reports that patients with severe mental illness are significantly less likely to receive therapies of proven benefit for problems with cholesterol, diabetes, hypertension or heart disease. Those who have survived a heart attack are less likely to receive appropriate medications, cardiac catheterisation procedures or bypass surgery than heart-attack patients without mental illness.

The CATIE study found that 88 percent of patients entering the study with high cholesterol did not take lipid-lowering drugs. Another 30 percent with diabetes at the start of the study received no anti-diabetes medications, and 62 percent of those with high blood pressure were not taking any antihypertensive medication.

Those with severe psychiatric illness also are less likely to be screened for high cholesterol, high blood pressure or diabetes despite the evidence of increased risk in general and specific evidence that some antipsychotic drugs can have adverse effects on body weight, glucose metabolism and lipid levels.

He also added that another problem is that lifestyle interventions that encourage healthy eating, smoking cessation and exercise can be difficult enough in the general population, but they are even more difficult when patients with schizophrenia or other mental disorders are involved.

Newcomer said that to lower risk of cardiovascular complications, psychiatrists may need to regularly weigh their patients, take blood pressure and screen appropriately for blood glucose, cholesterol and triglycerides.

“We’re not saying psychiatrists should start prescribing lipid-lowering agents or diabetes drugs, but they are on the ‘front lines,’ seeing psychiatric patients much more than primary-care providers. It’s important that psychiatrists begin to employ some of these basic screening techniques,” Newcomer says.

He also said that it’s vital that patients with severe mental disorders receive needed psychiatric medications, even though some of those drugs may contribute to weight gain, abnormal lipid levels and risk for cardiovascular disease and diabetes.

He believes that if such strategies can be developed and implemented, it is possible to quickly lower rates of cardiovascular disease and increase life expectancy in this population.

The new study is published in the Journal of the American Medical Association (JAMA). (ANI)

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