- New Survey Indicates There is Room for Improvement in Physical
Health Management Strategies for People Living With Schizophrenia
New data presented at the 15th European Congress of Psychiatry
(AEP) indicates that the impact of weight gain and metabolic
abnormalities associated with antipsychotic treatment now tops the
list as the most problematic effect of antipsychotic treatment,
according to 84 percent of European psychiatrists surveyed(1).
The European Physical Health in Schizophrenia Survey (PHSS) was
mailed to more than 50,000 psychiatrists and, to date, 4,220
responses have been analysed from 14 countries. The respondents rated
areas of concern, monitoring of physical health and the impact of
antipsychotic therapy as it relates to physical health by completing
a 10-question survey.
While 87 percent of psychiatrists rated physical health as
important to extremely important, less than half (42%) reported that
they regularly monitor their patients' physical health during routine
The shift in prescribing patterns from first generation to second
generation antipsychotics has helped alleviate some of the
debilitating and often socially isolating side effects of
extrapyramidal symptoms, as well as providing a broader range of
symptom control(2-4). However, not all second generation
antipsychotics are the same and some have been associated with
significant weight change and metabolic abnormalities(5). This has
resulted in an increased interest in the metabolic parameters of
patients and the drugs that treat schizophrenia.
The association between patients treated for schizophrenia and
metabolic abnormalities is well established and(6), although the
underlying cause is not fully understood, the impact is significant.
People living with schizophrenia are twice as likely to die from
cardiovascular disease than the general population(7) which is due
in part to the higher prevalence rates of cardiovascular risk factors
such as hypertension, dyslipidemia, obesity and diabetes in this
The survey results indicate that with respect to impact of
physical health on patients, compliance poses the biggest concern
(41%), followed by increased mortality (37%). Again, despite the high
importance psychiatrists place on physical health, the frequency of
physical health examinations rates were low, with 16 percent claiming
never to have conducted a physical exam, 27 percent at first
consultation only and less than half (42%) at almost every
Dr Helen L. Millar, Consultant Psychiatrist, Carseview Centre,
Scotland commented, "While symptom control is the primary goal of
treatment in schizophrenia, the impact of treatment-emergent weight
gain and other metabolic problems cannot be overlooked. Introducing
simple and consistent health checks along with healthy lifestyle
interventions will only help us, as Psychiatrists, to provide a
better quality of care for our patients and optimise treatment
selection to meet the individual needs of the patient."
In the survey, psychiatrists were asked how they would deal with
treatment-emergent weight gain and the results highlighted that more
can be done:(1)
- While 86 percent provide diet/lifestyle education and 53 percent
monitor weight, a majority of psychiatrists (67%) consider weight
gain intervention programmes unsuccessful
- 53 percent report they would consider an adjustment to
medication and 52 percent would consider a switch of medication
- 29 percent of patients are referred to an obesity
- Only 6 percent monitor waist measurement which is a simple,
non-invasive test for early diabetes and obesity(12).
"The time has come where Psychiatrists can no longer simply treat
the mental health problems of their patients in isolation to their
physical health needs. Fortunately, we are beginning to see an
increase in the level of awareness of the physical health problems
facing our patients with schizophrenia. However, we still have a long
way to go as many of the risk factors remain undetected and untreated
leading to people with schizophrenia being exposed to long-term
physical health complications. By choosing the most appropriate
antipsychotic with as few side effects as possible and introducing
simple health checks, such as weight and waist measurements along
with blood pressure, into routine exams we can start to treat
patients in a more holistic way and offer them with a better quality
of life", Dr Helen L. Millar also commented.
This survey highlights the crucial role that psychiatrists can
play in managing physical health. Incorporating simple monitoring
systems into daily clinical practice today can help prevent
unnecessary co-morbid conditions such as weight gain and may help
improve the quality of life of patients with schizophrenia. Health
care monitoring is an important step in reducing the life expectancy
gap between people with schizophrenia and the general population.
About Bristol-Myers Squibb and Otsuka Pharmaceutical Co., Ltd.
Bristol-Myers Squibb Company and Otsuka Pharmaceutical Co., Ltd.
are collaborative partners in the development and commercialisation
Aripiprazole was discovered by Otsuka Pharmaceutical Co., Ltd.
Founded in 1964, Otsuka Pharmaceutical Co., Ltd. is a healthcare
company with the mission statement: "Otsuka - people creating new
products for better health worldwide." Otsuka researches, develops,
manufactures and markets innovative, original products, focusing its
core businesses on pharmaceutical products for the treatment of
disease and consumer products for the maintenance of everyday health.
The Otsuka Pharmaceutical Group comprises 87 companies and employs
approximately 27,000 people in 17 countries and regions worldwide.
Bristol-Myers Squibb (NYSE: BMY) is a global pharmaceutical and
related health care products company whose mission is to extend and
enhance human life.
1. D Saravane, HL Millar, L Hanssens, F Moutard-Martin for the
PHSS study board. What are the Concerns of European Psychiatrists
Regarding Physical Health of Patients with Schizophrenia? Presented
at the 15th Association of European Psychiatry (AEP) 2007.
2. Stahl SM. Dopamine system stabilizers, aripiprazole, and the
next generation of antipsychotics, part 1, "Goldilocks" actions at
dopamine receptors. J Clin Psychiatry 2001; 62: 841-2.
3. APA. American Psychiatric Association. Practice Guideline for
the Treatment of Patients With Schizophrenia. Second Edition, 2004.
4. NICE. Guidance on the Use of Newer (Atypical) Antipsychotic
Drugs for the Treatment of Schizophrenia. In. London, UK: National
Institute for Clinical Excellence, 2002.
5. American Diabetes Association. Consensus development conference
on antipsychotic drugs and obesity and diabetes. Diabetes Care.
6. Lieberman, JA, 3rd. Metabolic changes associated with
antipsychotic use. Prim Care Companion J Clin Psychiatry, 2004.
6(Suppl 2): p. 8-13.
7. Casey, DE, DW Haupt, JW Newcomer, et al. Antipsychotic-induced
weight gain and metabolic abnormalities: implications for increased
mortality in patients with schizophrenia. J Clin Psychiatry, 2004.
65(Suppl 7): p. 4-18.
8. Allison, DB, KR Fontaine, M Heo, et al. The distribution of
body mass index among individuals with and without schizophrenia. J
Clin Psychiatry, 1999. 60(4): p. 215-20.
9. Herran, A, A de Santiago, M Sandoya, et al. Determinants of
smoking behaviour in outpatients with schizophrenia. Schizophr Res,
2000. 41(2): p. 373-81.
10. Goff, DC, C Cather, AE Evins, et al. Medical morbidity and
mortality in schizophrenia: guidelines for psychiatrists. J Clin
Psychiatry, 2005. 66(2): p. 183-94; quiz 147, 273-4.
11. Davidson, S, F Judd, D Jolley, et al. Cardiovascular risk
factors for people with mental illness. Aust N Z J Psychiatry, 2001.
35(2): p. 196-202.
12. Diabetes UK. Position Statement: Early identification of
people with Type 2 diabetes. 2006.
Notes to Editors:
- The Association of European Psychiatry is host to the annual
European Congress of Psychiatry and was founded in 1983. It is the
largest international association of psychiatrists in Europe with
members in 58 countries. The mission of the AEP is to improve the
quality of mental health care throughout Europe, by enhancing the
standard of psychiatric education and training, promoting excellence
in psychiatric research and encouraging progress in psychiatric
ABOUT EXTRAPYRAMIDAL SYMPTOMS:
- Extrapyramidal symptoms, often abbreviated as EPS, is a
neurological side effect of antipsychotic medication. EPS can occur
within the first few days or weeks of treatment, or it can appear
after months and years of antipsychotic medication use.
- EPS is more common among patients taking typical antipsychotic
medications, compared to the newer atypical drugs. More than 60% of
the people who take typical antipsychotic medications experience some
form of EPS.
- EPS can cause a variety of symptoms, e.g. involuntary movements,
tremors and rigidity, body restlessness, muscle contractions and
changes in breathing and heart rate.
ABOUT THE PSYCHIATRIST PHYSICAL HEALTH SURVEY
The survey was commissioned by Bristol-Myers Squibb and Otsuka
Pharmaceuticals. Psychiatrists responded to a 10-question survey. To
date over 5,000 psychiatrists have opted to complete this survey and
the figures included in this report are from the initial analysis of
the first 4,220 respondents.
- About the scales used in the survey:
- Psychiatrists rated importance of physical health using a
7-point scale, whereby 1 = not important & 7 = extremely important.
- Success of programme to control weight gain was rated on a
scale whereby 0% = failure & 100% = success.
ots Originaltext: Bristol-Myers Squibb Company AND Otsuka Pharmaceutical Europe Ltd
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. Alison Ross, Otsuka
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