Your SlideShare is downloading. ×
Physical monitoring in Mental Illness - Dr Sadgun Bhandari
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Physical monitoring in Mental Illness - Dr Sadgun Bhandari

288
views

Published on

Physical monitoring in Mental Illness - Dr Sadgun Bhandari is a recognized member of the Royal College of Psychiatrists, UK and also a Fellow of the Royal College of Psychiatrists, UK.

Physical monitoring in Mental Illness - Dr Sadgun Bhandari is a recognized member of the Royal College of Psychiatrists, UK and also a Fellow of the Royal College of Psychiatrists, UK.

Published in: Health & Medicine

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
288
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. PHYSICAL MONITORING IN SERIOUS MENTAL ILLNESS • DR SADGUN BHANDARI • CONSULTANT PSYCHIATRIST • QUEEN ELIZABETH II HOSPITAL • WELWYN GARDEN CITY • HERTFORDSHIRE • UK
  • 2. PSYCHIATRIC PERSPECTIVE IS MONITORING NECESSARY? • THE PHYSCIAL HEALTH OF THE SEVERELY MENTALLY
  • 3. PSYCHIATRIC PERSPECTIVE • Relative Risk of Cardiovascular and Cancer Mortality in People With Severe Mental Illness From the United Kingdom's General Practice Research Database • David P. J. Osborn, PhD; Gus Levy, MSc; Irwin Nazareth, PhD; Irene Petersen, PhD; Amir Islam, MBA; Michael B. King, PhD • Arch Gen Psychiatry. 2007;64(2):242249.
  • 4. PSYCHIATRIC PERSPECTIVE • A total of 46 136 people with SMI and 300 426 without SMI were selected for the study. • Hazard ratios (HRs) for CHD mortality • • • • • 18 through 49 years old, 3.22 (95% confidence interval [CI], 1.99-5.21) 50 through 75 years old, 1.86 (95% CI, 1.63-2.12) for those and 1.05 (95% CI, 0.92-1.19) for those older than 75 years.
  • 5. PSYCHIATRIC PERSPECTIVE • For stroke deaths, • • • • • • 18 through to 49 HRs were 2.53 (95% CI, 0.99-6.47) 50 through 75 years old, 1.89 (95% CI, 1.50-2.38) older than 75 years 1.34 (95% CI, 1.17-1.54) • Increased HRs for CHD mortality occurred irrespective of sex, SMI diagnosis, or prescription of antipsychotic medication during follow-up. • However, a higher prescribed dose of antipsychotics predicted greater risk of mortality from CHD and stroke.
  • 6. PSYCHIATRIC PERSPECTIVE • Risk for coronary heart disease in people with severe mental illness • Cross-sectional comparative study in primary care • DAVID P. J. OSBORN, PhD Department of Mental Health Sciences, Royal Free and University College Medical School, London • IRWIN NAZARETH, PhD • Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London • MICHAEL B. KING, PhD • Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
  • 7. PSYCHIATRIC PERSPECTIVE • Participants with SMI were almost twice as likely to have a raised 10-year CHD risk score as patients in the general practice comparison group. • The main excess risk factors were increased smoking, lower HDL-cholesterol levels, higher total cholesterol/HDL-cholesterol ratios, increased likelihood of a diagnosis of diabetes, and a weak propensity for raised blood pressure with advancing age. • Dyslipidaemia and diabetes were more common regardless of antipsychotic medication, and despite the fact that body mass indices were similar in the two groups.
  • 8. PSYCHIATRIC PERSPECTIVE • DO THEY GET THE RIGHT HELP?
  • 9. PSYCHIATRIC PERSPECTIVE • Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980-1998 • DAVID M. LAWRENCE, PhD and CASHEL D'ARCY J. HOLMAN, PhD Department of Public Health, The University of Western Australia, Perth, Western Australia • ASSEN V. JABLENSKY, DMSc • Department of Psychiatry and Behavioural Science, The University of Western Australia, Perth, Western Australia • MICHAEL S. T. HOBBS, DPhil • Department of Public Health, The University of Western Australia, Perth, Western Australia
  • 10. PSYCHIATRIC PERSPECTIVE • There were 44 767 deaths due to IHD during 1980-1998. Of these deaths, 3796 occurred in users of mental health services. The standardised mortality rate was almost twice as high in users of mental health services than in the overall population. • The majority of deaths (59%) were ascribed to acute myocardial infarction; however, the mortality rate ratio was higher for other IHD (most of these deaths were coded to coronary atherosclerosis, ICD—9 414.0, or unspecified chronic ischaemic heart disease, ICD—9 414.9).
  • 11. PSYCHIATRIC PERSPECTIVE • When examining procedure rates by diagnosis, it is clear that patients with schizophrenia have a much lower rate of cardiovascular procedures, even though these patients have among the highest levels of smoking, obesity and other cardiovascular risk factors.
  • 12. PSYCHIATRIC PERSPECTIVE • Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Nasrallah HA, Meyer JM, Goff DC, McEvoy JP, Davis SM, Stroup TS, Lieberman JA. University of Cincinnati, Cincinnati, OH 452670559, USA. NASRALHA@ucmail.uc.edu
  • 13. PSYCHIATRIC PERSPECTIVE • Rates of non-treatment ranged from 30.2% for diabetes, to 62.4% for hypertension, and 88.0% for dyslipidemia.
  • 14. PSYCHIATRIC PERSPECTIVE • WHAT SHOULD WE DO? • EVERY PATIENT WITH SMI IRRESPECTIVE OF WHAT ANTIPSYCHOTICS THEY ARE ON SHOULD HAVE REGULAR PHYSCIAL MONITORING
  • 15. PSYCHIATRIC PERSPECTIVE • The Mount Sinai Conference, held October 17–18, 2002, at the Mount Sinai School of Medicine in New York City, was organized by individuals who shared the belief that the health needs of people with schizophrenia who take antipsychotic medications typically are not adequately addressed by clinicians in specialty mental health programs or in primary care settings.
  • 16. PSYCHIATRIC PERSPECTIVE • • • • • • Weight Gain and Obesity Monitor and chart BMI Body Mass Index (BMI) 18.5-25 (kg/m2) Monitor waist measurement. If BMI over 25 before commencing antipsychotics due consideration should be given to the relative risk of different antipsychotics to cause weight gain.
  • 17. Antipsychotics & Weight Gain (Zimmerman et al 2003) • Marked Clozapine Olanzapine Zotepine Quetiapine Chlorpromazine Thioridazine Perphenazine Trifluperazine • Moderate Risperidone Clopenthixol Sulpride Amisulpride Haloperidol Fluphenazine Flupenthixol
  • 18. Antipsychotics & Weight Gain • No weight change Ziprasidone • Weight loss Molindone Pimozide • Low potential for weight change Aripiprazole
  • 19. PSYCHIATRIC PERSPECTIVE • Interventions include dietary advice, weight reduction, in some cases consider change of medication, medication to reduce weight. • Smoking cessation.
  • 20. PSYCHIATRIC PERSPECTIVE • Diabetes • A baseline measure of plasma glucose level should be collected for all patients before starting a new antipsychotic. • Those at higher risk should have another level at 4 months and then yearly. • Fasting ≤ 6mmol/L
  • 21. PSYCHIATRIC PERSPECTIVE • Hyperlipidemia • Measurements of total cholesterol, lowdensity lipoprotein (LDL) and HDL cholesterol, and triglyceride levels. • Lipid screening should be carried out at least once every 2 years when the LDL level is normal and once every 6 months when the LDL level is greater than 130 mg/dl.
  • 22. PSYCHIATRIC PERSPECTIVE • Total cholesterol <5mmol/L • LDL <3 mmol/L • HDL >1 mmol/L • Triglycerides <2 mmol/L
  • 23. PSYCHIATRIC PERSPECTIVE • QT Prolongation • Risk factors: a personal history of syncope, a family history of sudden death at an early age (under age 40 years, especially if both parents had sudden death), or congenital long QT syndrome. The recommendation is for ziprasidone.
  • 24. PSYCHIATRIC PERSPECTIVE • Elevated Prolactin Levels and Sexual Side Effects • Ask women about changes in menstruation and libido and whether they have milk coming out of their breasts. • Men should be asked about libido and erectile and ejaculatory function.
  • 25. PSYCHIATRIC PERSPECTIVE • Extrapyramidal Side Effects, Akathisia, and Tardive Dyskinesia • Rule out any pre-existing reasons for tremor before initiating treatment. • Monitoring depends on whether the drug is first or second generation
  • 26. PSYCHIATRIC PERSPECTIVE • There is a risk of myocarditis for patients on clozapine. • Myocarditis should be suspected in clozapine-treated patients who present with unexplained fatigue, dyspnea, tachypnea, fever, chest pain, palpitations, other signs or symptoms of heart failure, or ECG findings, such as ST abnormalities and T wave inversions.
  • 27. PSYCHIATRIC PERSPECTIVE • Conclusions: • Psychiatrists should be aware of the physical health of the severely mentally ill. • Monitoring will lead to early identification of problems and increased uptake of treatment . • Close links with Primary Care need to be developed so that the physical health needs of the mentally ill are dealt with appropriately.
  • 28. PSYCHIATRIC PERSPECTIVE