Endocrinologists need to work closely with psychiatrists and those working in mental health to improve the physical health of patients with illnesses such as schizophrenia.
An Australian Diabetes Society (ADS) position statement, The prevention and management of type 2 diabetes in the context of psychotic disorders, has called for more ‘integrated, collaborative, multidisciplinary care’ for a particularly vulnerable and at-risk group of patients.
Lead author Associate Professor Roger Chen, director of diabetes services at the Concord Repatriation General Hospital and endocrinologist at Sydney Local Health District’s Collaborative Centre for Cardiometabolic Health in Psychosis, said the extent of cardiometabolic disorders including diabetes, prediabetes and hyperlipidaemia in patients with psychosis was not well appreciated.
“Basically despite the improvement in life expectancy in the general population due to interventions such as statins and revascularisation procedures, there is little evidence to show improvement has occurred in those with psychotic disorders,” he said.
“We are dealing with a potentially very sick population. The gap between life expectancy in the general population and those with psychosis has widened considerably so that those who have a psychotic disorder may have a life expectancy which is 25-30 years shorter than the general population.”
The statement, released for World Mental Health Day, said that antipsychotic medications may be associated with adverse metabolic effects – contributing to both weight gain and diabetes in patients with psychosis.
And while prescribing the most metabolically neutral drugs was ideal for a patient’s physical health, effective management of the psychosis had to take preference.
“The psychiatrist has to decide what is the best drug for the patient, ” Associate Professor Chen said.
The position statement emphasised the importance of intensifying advice and support for lifestyle modification such as diet and exercise to mitigate weight gain and diabetes risk.
Metformin might also have a potential role but would need to be used outside PBS guidelines in the absence of diabetes.
Associate Professor Chen stressed that patients with psychosis required regular monitoring of weight and waist measurement, blood pressure, blood glucose and serum lipids.
However a ‘tick sheet’ approach was not enough.
“The issue is that someone has to interpret those results and develop a management plan. The management will very much depend on the patient’s situation.”