Management of Medication-Related Cardiometabolic Risk in Patients with Severe Mental Illness
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PHYSICAL ACTIVITY (D WARBURTON, SECTION EDITOR)
Management of Medication-Related Cardiometabolic Risk in Patients with Severe Mental Illness Donna J. Lang & Alasdair M. Barr & Ric M. Procyshyn
Published online: 14 June 2013 # The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract Severe psychotic disorders, which on their own may be a risk factor for metabolic disorder and cardiovascular illness, are clinically compounded by the significant adverse side effects of antipsychotic medications. The majority of patients with severe psychotic disorders (i.e., schizophrenia, bipolar disorder, mania, and depression) must take antipsychotic medications to treat their psychoses and, subsequently, will require efficacious interventions to manage the metabolic consequences of pharmacologic treatment to mitigate excessive mortality associated with cardiovascular illness. We have reviewed the metabolic consequences of antipsychotic treatment and discussed pilot findings from a new nonpharmacologic intervention study looking at the clinical benefits of regular exercise as a management tool for the cardiometabolic risk factors in a cohort with severe mental illness. Keywords Mental illness . Cardiometabolic disorder . Antipsychotics . Exercise
D. J. Lang (*) Department of Radiology, University of British Columbia, Centre for Complex Disorders, British Columbia Mental Health and Addictions Research Institute, CFRI Bldg, Rm. 3A-124, 938 West 28th Ave, BC Children’s Hospital Site, Vancouver, BC, Canada V5Z 4H4 e-mail: [email protected] A. M. Barr Department of Pharmacology, British Columbia Mental Health and Addictions Research Institute, Vancouver, BC, Canada V5Z 4H4 R. M. Procyshyn Department of Psychiatry, British Columbia Mental Health and Addictions Research Institute, Vancouver, BC, Canada V5Z 4H4
Introduction Metabolic and Cardiovascular Disease in Severe Mental Illness Of all the mental disorders, those that fall under the umbrella of psychotic disorders are certainly the most disabling and most difficult to manage. Severe psychiatric deficits, including hallucinations, delusions, cognitive difficulties, and poor social and occupational functioning, plus a debilitating course of lifelong cognitive impairments are characteristic of patients diagnosed with schizophrenia, severe bipolar disorder, and chronic clinical depression [1]. These disorders are also characterized by significantly decreased life expectancy with the chief factors of this excess risk of death arising from cigarette smoking, obesity, metabolic disorders associated with diabetes, hypertension, and stroke [2, 3]. A recent survey of over 1000 subjects with psychotic disorders conducted in Australia noted that over 75 % of all patients were overweight or obese, 20 % suffered from diabetes and hypertension, and over 50 % of patients met criteria for metabolic syndrome, defined by a combination of central obesity plus 2 or more of the following risk factors: elevated HDL C levels, increased blood pressure, increased blood gl
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