Cardiometabolic Monitoring and Intervention in People with First Episode Psychosis

Abstract

Life expectancy in people with schizophrenia is 20% lower than in others, and men with schizophrenia die, on average, 20 years earlier than those without this condition. Although levels of suicide and other violent deaths are higher in people with schizophrenia, most of the increased mortality in this group is the result of higher levels of cardiovascular disease and other physical health problems. The major risk factors for cardiovascular disease include adverse lifestyle (cigarette smoking; physical inactivity; atherogenic diet), diabetes, dyslipidemia, hypertension, obesity, as well as non-modifiable risk factors such as age and family history of premature coronary heart disease.In the latest National Audit of Schizophrenia in UK, a major finding was the very significant deficiencies in the monitoring and management of physical health problems in people with schizophrenia. This finding prompted the College to work with several professional bodies to develop a quality improvement tool, the Lester Cardiometabolic Resource, to promote better physical health care for people with psychosis. The resource recommends these monitoring measures following initiation or change of antipsychotics and/or mood stabilizers: Weight -at baseline, weekly in the first 6 weeks, at 12 weeks and annually; Lifestyle review (i.e. smoking, diet and physical activity); Blood pressure (BP); Fasting plasma glucose (FPG)/HbA1c; Lipid profile -at baseline, at 12 weeks and annually; Personal/Family history of cardiovascular disease (CVD); Waist circumference (WC) -at baseline and annually.Here at the Institute of Mental Health, Singapore (IMH), the recommendation is for patients on atypical antipsychotics to have at least the following monitoring: Weight/BMI -at baseline and quarterly; WC -at baseline and annually; BP/FPG/Lipid profile -at baseline, at 12 th -24 th week and annually. In practice, there have been anecdotal reports of monitoring frequency far exceeding the recommended duration for various reasons.