Doctors' 'call to action'

[chetnarayan]

American Psychiatric Association sounds alarm on high risk of cardiovascular disease for schizophrenics

Psychiatrists say people with schizophrenia are at higher risk for cardiovascular disease, which can significantly shorten their lives, yet their doctors fail to provide treatment or prevention.

"This is one of the most important problems" clinicians face, said Dr. Roger McIntyre, an associate professor of psychiatry and pharmacology at the University of Toronto. He says recent studies have shown that people with schizophrenia - 1 percent of the adult population - die on average 15 to 20 years earlier than expected. And they are dying from medical problems such as heart disease, diabetes and stroke that could be addressed when doctors treat their mental illness. "These patients often don't have access to prevention or treatments," McIntyre said.

Four doctors talked about the medical problems that beset people with schizophrenia at a briefing conducted by the American Psychiatric Association yesterday in Toronto.

It has become clear that many of the antipsychotic medications used to treat schizophrenia cause weight gain and increase risk for diabetes. But McIntyre and the other doctors say many patients are already at increased risk for medical
metabolic problems even before they start psychiatric drugs.

"Our job is to identify whatever factors are modifiable," McIntyre said.

Dr. Henry Nasrallah, a professor of psychiatry, neurology and neuroscience at the University of Cincinnati College of Medicine, said "well-established risk factors are occurring at high levels and not being monitored."

It's been about five years since scientific reports began trickling in about the antipsychotic medicines and their ability to trigger metabolic problems, especially type 2 diabetes.

Many of the medications, though certainly not all, cause weight gain. Patients also are at extremely high risk for smoking and inactivity.

So yesterday's briefing was a "call to action" for psychiatrists to pay attention to their patients' weight, lipid profiles and metabolic measures. "This monitoring is not taking place now," Nasrallah said. "We need to attend to the physical health of our patients."

The psychiatrists said not all anti-psychotic medicines cause metabolic problems, and doctors need to match the patient with the drug. McIntyre stressed that all doctors need to encourage diet and exercise.