Monitor schizophrenia patients for metabolic syndrome

[kkmalaysia]

Patients with schizophrenia should be monitored regularly and treated early for type 2 diabetes and dyslipidemia, says a consultant endocrinologist.

“Patients with schizophrenia have elevated metabolic risks compared to the general population,” said Dr. Zanariah Hussein, of Putrajaya Hospital, during a symposium at the 12th Congress of ASEAN Federation for Psychiatry and Mental Health and 15th Malaysian Conference on Psychological Medicine in Kuala Lumpur. [Eur Psychiatry 2009;24:412-24]

Metabolic syndrome in schizophrenia patients is thought to be mostly caused by weight gain, which often occurs when they are being treated with atypical antipsychotics. There are different risks of weight gain with different groups of atypical antipsychotics – the highest risk is with clozapine and olanzapine, moderate risk with risperidone and quetiapine, and minimal risk with ziprasidone and aripiprazole, said Zanariah.

Therefore, she said, “It is very important to do metabolic monitoring at baseline and annually or 6-monthly to detect and diagnose metabolic problems early and correct them so they will be protected from overt diabetes and cardiovascular events.”

Experts have not been able to pinpoint the exact mechanism involved in the development of type 2 diabetes in patients on antipsychotics, but it could be related to hyperprolactinemia or insulin signaling, as some patients develop diabetes without gaining weight, she added.

The Clinical Practice Guidelines for Management of Schizophrenia in Adults 2009 strongly recommends that body mass index (BMI) and blood pressure (BP) be measured at every visit, fasting plasma glucose at baseline and annually, and triglycerides and HDL cholesterol levels at baseline and every 2 years after starting treatment. [table 4. Patient Monitoring Parameters, page 63 Available at www.acadmed.org.my/index.cfm?&menuid=67 Accessed on 28 July]

When metabolic syndrome is detected, Zanariah said most physicians will decide to stop the antipsychotic and switch to another agent that has less risk and the conditions can potentially slowly reverse. However, she noted that some patients may still have to be given the same antipsychotic, so these patients need to be treated for metabolic syndrome as well.

According to the US National Cholesterol Education Program, the management of metabolic syndrome involves reversing the root causes ie, obesity and physical inactivity. “We should advise patients to get moving and to adopt calorie restriction, and where we can we are to treat hypertension and dyslipidemia,” she said.

Patients can be determined to have metabolic syndrome simply by measuring their BP, waist circumference, lipid parameters, particularly triglycerides and HDL cholesterol, and fasting plasma glucose or checking for glucose intolerance, said Zanariah.

The latest definition of metabolic syndrome takes into account that different ethnicities have different risks eg, Asians have a higher risk of this clustering of metabolic risk factors at a lower BMI and lower waist circumference than Caucasians.

The joint statement incorporates waist circumference (90 cm for men and 80 cm for women in Malaysia), triglyceride (1.7 mmol/L in Malaysia), HDL cholesterol (1.0 mmol/L for men and 1.3 mmol/L for women in Malaysia), elevated BP or being treated with an antihypertensive, and elevated fasting glucose (>6.1 mmol/L in Malaysia). [Circulation 2009;120:1640-5]
 

Source: Medical Tribune