Monitoring and Treating Metabolic Abnormalities in Patients with Early Psychosis Initiated on Antipsychotic Medications

Bozymski, Kevin M; Whitten, Jessica; Blair, Mary E.; Overley, Ashley; Ott, Carol A.

doi:10.1007/s10597-017-0203-y

Cited by 11 publications

(12 citation statements)

References 41 publications

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“…The second generation drugs, however, have been linked to their own serious side-effects as well. These most commonly include cardiometabolic side-effects, which significantly increase the risk of developing cardiometabolic disorders such as Type 2 diabetes mellitus (DM) and cardiovascular disease (11)(12)(13)(14)(15)(16)(17)(18)(19). Typically, Type 2 DM is preceded by the onset of the metabolic syndrome, which is characterized by weight gain, hypertension, hyperlipidemia, hyperglycemia, glucose intolerance, and insulin resistance (20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

Boyda

Tse

et al. 2020

Front. Psychiatry

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Antipsychotic drugs represent the most effective treatment for chronic psychotic disorders. The newer second generation drugs offer the advantage of fewer neurological side-effects compared to prior drugs, but many cause serious metabolic side-effects. The underlying physiology of these side-effects is not well-understood, but evidence exists to indicate that the sympathetic nervous system may play an important role. In order to examine this possibility further, we treated separate groups of adult female rats acutely with either the first generation antipsychotic drug haloperidol (0.1 or 1 mg/kg) or the second generation drugs risperidone (0.25 or 2.5 mg/kg), clozapine (2 or 20 mg/kg), olanzapine (3 or 15 mg/kg) or vehicle by intraperitoneal injection. Blood samples were collected prior to drug and then 30, 60, 120, and 180 mins after treatment. Plasma samples were assayed by HPLC-ED for levels of norepinephrine, epinephrine, and dopamine. Results confirmed that all antipsychotics increased peripheral catecholamines, although this was drug and dose dependent. For norepinephrine, haloperidol caused the smallest maximum increase (+158%], followed by risperidone (+793%), olanzapine (+952%) and clozapine (+1,684%). A similar pattern was observed for increases in epinephrine levels by haloperidol (+143%], olanzapine (+529%), risperidone (+617%) then clozapine (+806%). Dopamine levels increased moderately with olanzapine [+174%], risperidone [+271%], and clozapine [+430%]. Interestingly, levels of the catecholamines did not correlate strongly with each other prior to treatment at baseline, but were increasingly correlated after treatment as time proceeded. The results demonstrate antipsychotics can potently regulate peripheral catecholamines, in a manner consistent with their metabolic liability.

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Section: Introductionmentioning

confidence: 99%

Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

Boyda

Tse

et al. 2020

Front. Psychiatry

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“…One study was based in early intervention/psychosis services [86] and one based in other (mix of urban, non-urban and metropolitan centres) [71,72]. Pharmacists were involved to some extent in delivering the interventions across all studies, and those involved were mostly commonly specialist mental health/psychiatric pharmacists (n = 9) [73,79,83,[85][86][87][88][89][90] or clinical pharmacists (n = 9) [76,78,81,82,[91][92][93][94][95] (Table 4). Differences in terminology across studies due to differences in country of origin did not allow us to differentiate grades or qualification of pharmacists.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…Quasi experimental approaches were utilised in thirteen [86,88,92,94,95,[97][98][99][100][101][102][103][104] of the quantitative, outcome studies, (n=12) [86, 88, 92, 94, 95, 97-101, 103, 104] of these scored more than 50%. Seventy-one percent [71,85,87,90,91,93] (n = 5) of the quantitative descriptive studies scored 50% or more.…”

Section: Summary Of Quality Assessmentmentioning

confidence: 99%

“…Three studies [81,82,86] included CVD risk assessment and none included diabetes risk assessment using formal tools/calculators. Fifteen percent of the studies [78,87,92,99] included waist circumference as an outcome measure-this may reflect a lack of understanding of its importance as a predictor of CVD or lack of inclusion in guidelines on which study protocols were based. Taveira [81] concluded that patients with diabetes and with mental health conditions (MHCs) achieve the same CVD risk reduction (using a formal CVD risk assessment calculator as an outcome measure) as those without MHCs.…”

Section: Application Of Risk Assessment Tools/calculatorsmentioning

confidence: 99%

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The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

et al. 2021

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Background Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness. Methods A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool. Results A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data. Conclusions Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies. Systematic review registration PROSPERO CRD42018086411

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“…To identify any emerging physical health issues, there are also guidelines outlining the importance of this group of consumers receiving regular metabolic screening and monitoring as soon as they commence taking antipsychotic medications ( Alvarez-Jim enez et al 2010; Curtis et al 2011;Foley & Morley 2011). However, low rates of routine metabolic screening and monitoring by mental health professionals continue to be reported (Bozymski et al 2017;Ward et al 2018).…”

Section: Introductionmentioning

confidence: 99%

The physical health of young people experiencing first‐episode psychosis: Mental health consumers’ experiences

Chee

Wynaden

Heslop

2018

Int J Mental Health Nurs

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Young people experiencing first-episode psychosis taking antipsychotic medications often develop comorbidities such as obesity and cardiometabolic abnormalities at an earlier age than young people in the general population. Therefore, it is important to explore the healthcare needs and experiences of this group of consumers. This paper reports research conducted to obtain an informed understanding of young people's health literacy, physical healthcare needs, and interest and knowledge about their physical health. Grounded theory methodology was used to guide the research. Semistructured interviews were conducted with 24 young consumers aged between 18 and 35 years who were case managed by one metropolitan community mental health service. The results describe the journey of young people from the time of diagnosis, to when they developed an awareness of the need to improve their physical health and the impact of physical health issues on their overall health and well-being. Six categories emerged from the data: (i) initial responses when diagnosed with first-episode psychosis; (ii) focus of care on treating first-episode psychosis; (iii) lack of education on antipsychotic medications; (iv) adverse effects from taking antipsychotic medication; (v) increased awareness of the need for good physical health; and 6) importance of social support in the community. The findings highlight the importance for health professionals improving young people's health literacy and addressing physical health and well-being as part of first-episode psychosis programmes. Young people require improved health education on the importance of maintaining healthy lifestyle in relation to their overall health and well-being.

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Monitoring and Treating Metabolic Abnormalities in Patients with Early Psychosis Initiated on Antipsychotic Medications

Cited by 11 publications

References 41 publications

Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

The physical health of young people experiencing first‐episode psychosis: Mental health consumers’ experiences

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