Minding metabolism: targeted interventions to improve cardio-metabolic monitoring across early and chronic psychosis

Abstract

Background Antipsychotics (APs) increase weight, metabolic syndrome, diabetes and cardiovascular disease. Guidelines recommend cardio-metabolic monitoring at initial assessment, at 3 months and then annually in people prescribed APs. Aim To determine the rates of cardio-metabolic monitoring in AP treated early and chronic psychosis and to assess the impact of targeted improvement strategies. Methods Medical records were reviewed in two cohorts of first-episode psychosis (FEP) patients before and after the implementation of a physical health parameter checklist and electronic laboratory order set. In a separate group of patients with chronic psychotic disorders, adherence to annual monitoring was assessed before and 3 months after an awareness-raising educational intervention. Results In FEP, fasting glucose (39% vs 67%, p =0.05), HbA1c (0% vs 24%, p =0.005) and prolactin (18% vs 67%, p =0.001) monitoring improved. There were no significant differences in weight (67% vs 67%, p =1.0), BMI (3% vs 10%, p =0.54), waist circumference (3% vs 0%, p =1.0), fasting lipids (61% vs 76% p =0.22) or ECG monitoring (67% vs 67%, p =1.0). Blood pressure (BP) (88% vs 57%, p =0.04) and heart rate (91% vs 65%, p =0.03) monitoring dis-improved. Diet (0%) and exercise (<15%) assessment was poor. In chronic psychotic disorders, BP monitoring improved (20% vs 41.4%, p =0.05), whereas weight (17.0% vs 34.1%, p =0.12), BMI (9.7% vs 12.1%, p =1.0), fasting glucose (17% vs 24.3%, p =0.58) and fasting lipids remained unchanged (17% vs 24.3%, p =0.58). Conclusions Targeted improvement strategies resulted in a significant improvement in a limited number of parameters in early and chronic psychotic disorders. Overall, monitoring remained suboptimal.

Altered Intestinal Permeability Biomarkers in Schizophrenia: A Possible Link with Subclinical Inflammation

“… 34 Interestingly, patients with SCZ are prone to develop cardiometabolic abnormalities. 35 As a biomarker for LPS-induced innate immune responses, our data showed that plasma levels of LBP were correlated with NLR.…”

“… 39 Studies have reported that LBP and specific transfer proteins play an important role in transferring LPS from HDLs to LDLs. 40 Because patients with SCZ are more prone to develop metabolic abnormalities and are characterized by decreased HDL levels, 35 it is conceivable that LPS may get redistributed in circulation and this may induce proinflammatory reactions on several peripheral tissues related to the pathoetiology of SCZ. In this context, the inverse correlation of zonulin levels with HDL cholesterol observed in our study is an important finding.…”

Use of Psychoeducation for Psychotic Disorder Patients Treated With Modern, Long-Acting, Injected Antipsychotics

“…These metabolic issues are potentially life-threatening effects and need to be carefully assessed and treated by clinicians ( 8 , 9 ). Also, strategies of prevention need to be employed and awareness regarding their own general health needs to be addressed among these patients ( 10 ). International organizations have proposed guidelines for screening and preventing metabolic issues in patients treated with antipsychotics suggesting physical monitoring and psycho-education in the long-term treatment ( 11 , 12 ).…”