Excess mortality can be addressed
SAN DIEGO — Clinicians treating patients with schizophrenia should be monitoring blood pressure, insulin resistance, and lipids as carefully as they monitor somnolence, auditory hallucinations, and akinesia, because those are the markers for the conditions that will likely kill them.
That means that mental health professionals need to team up with those that treat the chronic medical conditions that are common commodities of schizophrenia: diabetes mellitus, coronary artery disease, dyslipidemia, and heart failure, said Vladimir Maletic, MD, MS, clinical professor of neuropsychiatry and behavioral science at the University of South Carolina School of Medicine in Greenville, South Carolina.
He noted that serious mental health illness currently affects about 4.5% of the U.S. population, but the risk for premature death is significantly greater in this segment of the population. “Mental illness does shorten life,” Maletic said. “Some studies estimate that life-expectancy can be shortened by as much as 25 years, but others put it at 11-15 years. In schizophrenia, we estimate that life is shortened by 12 years — 12 years is a lot of life to lose.”
The question facing the mental health provider community is twofold: “What is it that shortens life, and is there anything that we can do to make a difference,” he asked some 400 Psych Congress 2019 attendees during a lunchtime session titled “Keep the Body in Mind.”
Some factors, he said, are well known — for example, the suicide rate is about 7.5 times higher among persons diagnosed with schizophrenia than in the general population.
And, it is also recognized that treating schizophrenia — getting patients on medications and keeping them adherent — can reduce excess mortality by 50%. “But in absolute numbers, it is cardiometabolic disease that kills more than suicide,” he said.
Some of that risk has been attributed to treatment with antipsychotic medications — weight gain, for instance, is a known side-effect for many psychotropic drugs, and obesity is a driver of cardiovascular disease and diabetes. But Maletic said that the pathophysiology of schizophrenia is also a factor. To illustrate, he pointed to data from the CATIE trial, a landmark trial of close to 1,500 patients that established the efficacy of olanzapine. “At baseline, before any exposure to antipsychotic medications, 10% of the participants had diabetes,” he said.
The diabetes risk, according to Maletic, is related to plasma adiponectin levels in persons with schizophrenia.
Recognizing the cardiometabolic risk is not enough — it needs to be treated. Maletic said that recent analyses suggest that among persons with schizophrenia, 48% of dyslipidemia is untreated, as is 33% of hypertension, 66% of diabetes, and 33% of obesity.
Asked how clinicians can change that picture, Maletic had some simple advice: “Check weight and waist circumference at baseline, then 3 months after initiating treatment, and yearly thereafter. Ask the primary care provider to share lab reports annually. Consult with the primary care providers on your team.”
Written by Peggy Peck, Editor-in-Chief, BreakingMED, is a service of @Point of Care, LLC, which provides daily medical news reports curated to serve the unique needs of busy physicians and other healthcare professionals.