Metabolic syndrome and antipsychotic drugs

Mental Health Nursing,  Nov 2006  by Pulzer, Matthew

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Matthew Pulzer reports from GAMIAN-Europe and EUFAMI on the UNITE survey.

A growing body of evidence suggests that people with schizophrenia and bipolar disorder may be at an increased risk for metabolic disorders leading to metabolic syndrome (see box). This has far reaching consequences, as these people are more likely to suffer from cardiovascular disease (CVD) and, as such, have a higher rate of mortality than the general population (the cardiovascular mortality rate is more than twice as high in men with schizophrenia when compared to the general population (Ösby, 2000). In fact, patients with mental illness are more likely to die from cardiovascular disease than suicide (Brown S, 1997). Increasing concern about these issues led to a multinational survey (UNITE) of mental health patient care. It is one of the largest ever global patient and carer surveys in psychiatry (UNITE Survey, 2006) and 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 CVD, diabetes and death (Yusuf, 2004).

These increased risks have been acknowledged for some time and there is growing evidence that they are exacerbated by treatment with some antipsychotic drugs (Newcomer, 2005) - 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, 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. (UNITE, 2006)

UNITE survey

The UNITE survey (Understanding patients' Needs, Interactions, Treatment & Expectations (UNITE, 2006)) was designed to gain an understanding of the nature and perceptions of people with schizophrenia and bipolar disorder and their carers, on the care they receive. Online interviews were conducted with 540 people per country in each of 11 countries to compare the management of mental health in each participating country. The key results presented here encompasses eight countries: France; Germany; Italy; Spain; Sweden; Greece; UK, US. (Additional countries not presented here are: Australia; South Korea; Brazil.) The survey questions asked related to the respondent's current medical care, in particular, focusing on:

* Interactions within the physician's office

* Side effects experienced

* Long-term effects of treatment received.

Methodology

Web-based methods were used to obtain the sample, providing a novel, timely and more cost effective approach. The participants were either people with schizophrenia or bipolar disorder or carers of people with schizophrenia or bipolar disorder. The people with schizophrenia or bipolar had a self-confirmed diagnosis and were all taking prescription medicines as part of treatment for their disorder. The carers had to provide care for a friend or family member for at least three hours per week and their friend or family member was required to be on prescription medicine as part of their treatment.

For each type of respondent (person with schizophrenia, person with bipolar disorder, carer of person with schizophrenia and carer of person with bipolar disorder), the target sample size was 135. On a per country basis, 540 total respondents correspond to an aggregate base size of approximately 6,000 participants across all the 11 countries.

For their participation, interviewees were given a small financial reward or access to a subscription medical information website.

Key results

The results outlined below are taken from data for the seven European countries and the US.

* The survey found that obesity, diabetes and high blood pressure were the most frequently diagnosed coexisting conditions for people with schizophrenia or bipolar disorder.

* Approximately three-quarters of people with schizophrenia or bipolar disorder reported weight gain; six out of ten carers reported weight gain for their friend/family member.

* The top unmet needs from their care, quoted by both patients and carers, were less risk of weight gain, better treatment of depression and improved functionality/quality of life.

* Around half of people with schizophrenia or bipolar disorder reported that their weight gain has generated additional health problems. In both groups, an increased cholesterol level was the most frequently cited health problem.

* The experience of gaining weight, negatively impacted many areas of daily life.

* Respondents reported that prescribers of medication for schizophrenia or bipolar disorder were shown to be addressing weight gain by discussing the long-term, physical impact.

* Moreover, respondents reported that prescribers were pro-active in suggesting ways to control weight gain, regardless of whether the person had gained weight or not.