No Images? Click here In This Issue - June 2019Guest Article: Metabolic Syndrome and Psychiatry by Dr. Joan C. Nagy, MD, BSc (OT), FRCP(C) METABOLIC SYNDROME AND PSYCHIATRYKEY MESSAGES
BACKGROUND Metabolic Syndrome affects an estimated 25% of the world population, and left untreated, it increases the risk of cardiovascular disease and type 2 diabetes. According to a Canadian study (2014), 19.1% of Canadian adults met the criteria for metabolic syndrome. The prevalence increases in older individuals. Metabolic syndrome is based on the presence of three of the following
The underlying causes of metabolic syndrome are not completely understood; however, insulin resistance and abdominal obesity are significant indicators. Other factors include genetics, physical inactivity, hormonal changes, pro-inflammatory state, and diet. Ethnic variations are also important, with non-European individuals being more susceptible. RISK OF METABOLIC SYNDROME IN THE TREATMENT OF PSYCHIATRIC DISORDERSPsychiatric disorders, particularly psychosis, are often treated with antipsychotic medication. However; they are also commonly used in other conditions, including bipolar affective disorder, severe depression, behavioural disorders, dementia, and autism. The newer atypical antipsychotics frequently result in significant weight gain even in the first weeks of treatment. Thus, diabetes may occur early in treatment. The highest risk of weight gain is with the use of Clozapine and Olanzapine, and somewhat less with other agents such as Risperidone, Quetiapine, Ziprasidone and Aripiprazole. The older conventional antipsychotics generally cause less weight gain; however, they often lead to unacceptable movement disorders, including extrapyramidal symptoms. Atypical antipsychotics have been more effective in preserving cognitive functioning and in mood enhancement, thus they have largely replaced the older antipsychotics. Monitoring and managing the metabolic syndrome is critical in both early identification of abnormalities and in tracking of the changes over time. There are a number of existing guidelines for monitoring. Most guidelines recommend
Tracking is increased if abnormalities occur, or in individuals at increased risk (e.g. with obesity or diabetes). Baseline measurements are ideally done before antipsychotics are initiated. Developing awareness and establishing monitoring of metabolic parameters is crucial. This requires collaboration and communication between specialists and general practitioners. BARRIERS IN MANAGEMENT
FOR ADDITIONAL INFORMATION Dr. Nagy graduated from McMaster University in Psychiatry in 1984, with a background in Occupational Therapy (McGill, 1974). She has vast experience working in private practice, with Family Health Teams, and in hospitals. She currently works in Adult Outpatient Psychiatry in Hamilton and Niagara, and has been with the Niagara ACT Team since 2006. She specializes in psychotherapy and psychotic disorders. For questions, please contact Dr. Nagy at joan.nagy@niagararegion.ca You can now receive Medical Advisories and Memos electronically from Niagara Region Public Health - subscribe here. |