European Mental Health Groups Unite To Issue Call To Action On Metabolics In Mental Health

Main Category: Mental Health
Also Included In: Depression;  Bipolar;  Psychology / Psychiatry
Article Date: 18 Sep 2006 - 8:00 PDT

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GAMIAN-Europe and EUFAMI today issued a call for action to address a growing crisis for people with mental illness - the relentless increase in CHD risk in this population. The statement followed presentation of the results of one of the largest ever global patient and carer surveys in psychiatry1. It was echoed by demands for the clinical community to urgently address the physical health of their patients, by leading international clinicians who dubbed the results 'staggering'.

The UNITE (Understanding patients' Needs, Interactions, Treatment & Expectations) Survey, which was supported by Pfizer Inc., revealed that almost three quarters of people with schizophrenia or bipolar disorder surveyed reported significant weight gain since being diagnosed with their mental illness. This causes major health complications, significantly raising the risk of cardiovascular disease (CVD), diabetes and death2.

These increased risks have been acknowledged for some time and there is growing evidence that they are exacerbated by treatment with some antipsychotic drugs3 - the mainstay of symptom control in these conditions. These risks are addressed in several guidelines for treatment, but the survey revealed that, despite scientific awareness, daily practice remains vastly different. Only a minority of respondents received adequate physical health checks. Less than a third of people with schizophrenia or bipolar disorder in Europe reported having their blood pressure checked and only one in four of them reported being regularly weighed.

Roger S. McIntyre, MD, Associate Professor of Psychiatry and Pharmacology at the University of Toronto commented: "This is a significant survey that shows a staggering rate of metabolic related co-morbidities. These are young people, very much in the prime of their lives, being exposed to decades more physical illness than those without schizophrenia and bipolar.

"It should also be highlighted that these medical conditions not only occur more frequently in these patients, but also disproportionately account for the excess mortality. This should be a wake up call to physicians to consider both psychiatric and medical aspects of the patients that they manage."

The UNITE Survey was specifically designed to gain an understanding of the perceptions of people with schizophrenia and bipolar and their carers about the nature of and level of satisfaction with their current medical care. It found that obesity, diabetes and high blood pressure are the most frequently diagnosed co-existing conditions for people with schizophrenia or bipolar disorder. Around three out of four people with schizophrenia or bipolar reported gaining weight in the duration of their disease. In addition around one in two people with either condition reported that this weight gain had led to additional health complications, citing increased cholesterol, diabetes and high blood pressure most frequently.

Rodney Elgie, past President of Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe) said "The physical health of people with severe mental illness has long been a cause for concern for GAMIAN. This is the first time that the patient voice has been heard with regard to this issue. We hope that the survey will raise awareness among physicians of the importance of treating the patient holistically. It is no longer acceptable to maintain an artificial division of above and below the neck when considering the treatment of a patient with a severe mental illness."

Kevin Jones, Secretary General of the European Federation of Associations of Families of People with Mental Illness (EUFAMI) added "People with schizophrenia and bipolar are already extremely vulnerable from their condition. As such, they and their families and carers have to place a huge trust in doctors to ensure they receive the best possible level of overall care. If they are not receiving this care then something needs to be done urgently."

Forty per cent of people with schizophrenia and 30 per cent of those with bipolar disorder reported gaining more weight than they deem acceptable to stay on their treatment. This is also corroborated in the responses of their carers, who report more weight gain than is acceptable to the point where their concordance with medication is questionable.

Dr Marc de Hert, clinical psychiatrist and psychotherapist working at the University Psychiatric Centre Katholieke Universiteit, Kortenberg, Belgium stated "The research to support the increase in metabolic complications in these populations has been there for years. There is an increased prevalence of obesity, dislipidaemia and glucose abnormalities in people with severe mental illness and this results in a greatly increased risk of cardiovascular disease."

In those with mental illness, the prevalence of traditional risk factors for CVD is already high4. The proportion of those who smoke is greater and there is a greater tendency for physical inactivity and poor diets5.

Second generation antipsychotics play an important role in the management of schizophrenia and bipolar disorder and lifelong use of them in these populations is widespread. However, certain antipsychotics have been associated with an increase in the prevalence of obesity, dislipidaemia and diabetes. Recent recommendations from the American Diabetes Association and American Psychiatric Association6, have not yet been matched by broad European guidance. However, a statement from the Belgian Consensus Group regarding initiating and maintaining therapy with second generation antipsychotics was issued recently7. The recommendations state that a greater degree of monitoring of metabolic factors should take place and treatment decisions, where there is equal efficacy, should be made on the basis of metabolic risk factors of the patient and the risk profile of the antipsychotic agent.

Dr de Hert, one of the members of the Belgian consensus group added "Our recommendations are that many simple measures can be undertaken to ensure that physical health as well as mental health is managed successfully. If there are any modifiable factors that the clinical community can change to lessen this burden then it is time they did something to address them."

About GAMIAN-Europe

The Global Alliance of Mental Illness Advocacy Networks is a pan-European patient driven organisation assisting people affected by mental illness, either as a sufferer or as a carer. The objectives of GAMIAN-Europe are to raise the profile and importance of mental illnesses among members of the European Parliament and the European Commission, to provide advice, information and support to enable member organisations to provide and improve upon the services that they offer to their own members, and to develop working relationships with health professionals within the mental health field.
www.gamian-europe-history.org

About EUFAMI Founded in 1992, EUFAMI is the European Federation of Associations of Families of People with Mental Illness. It is the representative body for family run voluntary organisations across Europe, which promotes the interests and well being of all people affected by severe mental illness. It is registered in Belgium as an international non-profit organisation.
www.eufami.org/index.pl/en