19.03.2007 – 09:05
84 Percent of Psychiatrists Surveyed Rank Weight Gain or Metabolic Impact as the Most Problematic Effect of Antipsychotic Treatment(1)
- 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 consultation(1).
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 patient population(7-11).
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 consultation.1
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 specialist/dietician
- 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.
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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. 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. 2004;27:596-601.
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 clinical practice.
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.
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