medical health in schizophrenia Flashcards
ALL-CAUSE MORTALITY IN SCHIZOPHRENIA
- average LE for individuals with schizophrenia has been estimated to be 10 to 30 years shorter than that of the general population.
- the leading cause of early deaths is coronary heart disease (CHD).
- CVD is responsible for more than 35 percent of deaths in SMI
CVS CAUSES MORTALITY
- CVS
a. The prevalence of CVD in people with schizophrenia is approximately two- to threefold increased, particularly in younger individuals.
b. ersons with schizophrenia have an increased prevalence of all key modifiable cardiovascular and metabolic risk factors, including obesity, smoking, hypertension, dyslipidemia, and hyperglycemia.
c. both sexes in the CATIE population have an elevated prevalence of cardiometabolic risk factors than controls, women more than men
d.
DM
- 2- 4 times more than gen population
- 15-18% prevalence in schizophrenia, 9% in gen Popen
- inc incidence of diabetes in earlier adults and prevalence maintained at higher levels
- risk factors: poverty, urbanization, crowding, psychological
stress, smoking, and the effects of treatments like antipsychotic medications on rates of obesity, insulin resistance and dyslipidemia, as well as genetic factors. - inc activation of HPA and sympathetic nervous system — acute hyperglycemia in drug naive pts
- inc adiposity or glucoregualtory impairment inconsistently observed
cancer
some studies show protective role , some opposite
protective effect, possibly genetic, that makes development of some cancers less likely, suggested to be similar to the protective effect conferred by sickle trait on malaria infection. This hypothesis is supported by analyses that suggest reduced incidence of multiple types of cancer in the first- degree relatives of schizophrenia patients
Obesity- and smoking-related cancers have previously been reported to be more prevalent in schizophrenia patients.
MCly in schizophrenia- lung cancer, breast cancer, uterine cancer
An increased risk of breast cancer may relate to the prolactin-elevating effects of commonly used antipsychotic medications, but may also relate to an increased incidence of insulin resistance, type 2 diabetes mellitus, and related metabolic abnormalities.
Given the elevated rates of obesity, insulin resistance, and type 2 diabetes associated with increased risk of breast and other obesity- and insulin resistance–associated cancers (e.g., colon, endometrial, gallbladder) in the mentally healthy, it is reasonable to consider that this association also contributes to the risk for developing these cancers in patients with schizophrenia
pulmonary disease
Increased abdominal adiposity, seen in many patients with schizophrenia, can contribute to the risk of COPD, just like in the general population, where increased abdominal mass restricts diaphragmatic excursion among other effects. However, the strongest independent risk factor for COPD is smoking. P
inc prevalence of modifiable risk factors
- overweight and obesity
- htn
- dyslipidemia
- insulin resistance
- metal syndrome
- smoking and sub use
Overweight and Obesity
Obesity is roughly twice as prevalent in people with schizophrenia, in comparison to the general population.
role of psychotropics
pharmacotherapies that decrease energy expenditure, via sedation or reduced motor activity, or increases caloric intake, via increased appetite or reduced satiety, can increase risk for body weight gain.
complex pharmacotherapy
division of AP a/to weight gain risk (sga)
high cloza olanz
mod quetiapine, risperidone, and asenapine
Aripiprazole, ziprasidone, lurasidone have the most limited effects on weight
htn
2x more than gen poplin
Increased adiposity and insulin resistance are associated with increased sympathetic nervous system activity and sodium retention,
Although measureable hypertension can be attenuated by the α1-adrenoceptor antagonism associated with some
medications, antipsychotic treatment-induced hypertension has been observed in context of substantial weight gain. Cigarette smoking may also be associated with increased blood pressure both acutely due to the stimulant effects of nicotine, and secondarily due to chronic smoking increasing risk of various forms of CVD.
Insulin Resistance and Hyperglycemia
1.5 to 2 times more common
The progression of insulin resistance to pancreatic β-cell failure and related hyperglycemia can progress to incident type 2 diabetes mellitus, which increases risk for morbidity and mortality from microvascular (i.e., retinopathy, neuropathy, and nephropathy) and macrovascular disease (i.e., CHD, cerebrovascular disease, peripheral vascular disease) complications.
Antipsychotics increase risk
ifestyle factors can certainly affect outcomes, with poor diet, inactivity, smoking, and lack of exercise commonly associated with overweight and obesity and insulin resistance in untreated nonpsychiatric
samples as well as in treated patients.
metal syndrome criteria
rom the third adult treatment panel (ATP III) of the National Cholesterol Education Program (NCEP), three or more of the following are required for diagnosis:
Abdominal obesity (waist circumference greater than 102 cm in men or greater than 88 cm in women),
elevated triglycerides (150 mg/dL or more),
decreased HDL cholesterol (less than 40 mg/dL in men or less than 50 mg/dL in women),
hypertension (blood pressure 130/85 mm Hg or more), or
hyperglycemia (fasting plasma glucose [FPG] 100 mg/dL or more).
primary prevention
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