WHEN DOES THE TROUBLE START? OBESITY, DIABETES RISKS AND METABOLIC DISTURBANCES IN YOUNG PEOPLE WITH PSYCHOSIS

Galletly, Cherrie; Schimmelmann, Benno Karl Edgar (April 2014). WHEN DOES THE TROUBLE START? OBESITY, DIABETES RISKS AND METABOLIC DISTURBANCES IN YOUNG PEOPLE WITH PSYCHOSIS. Schizophrenia Research, 153, S18. Elsevier 10.1016/S0920-9964(14)70058-1

People with psychotic disorders have higher mortality
rates compared to the general population. Most deaths are due to cardiovascular
(CV) disease, reflecting high rates of CV risk factors such as obesity
and diabetes.
Treatment with antipsychotic drugs is associated with weight gain in clinical
trials. However, there is little information about how these drugs affect
children and young people, and how early in the course of treatment the
elevation in CV risk factors begins. This information is essential in understanding
the costs and benefits of these treatments in young people, and
establishing preventive and early intervention services to address physical
health comorbidities.
This symposium reports both prospective and naturalistic data from children
and adolescents treated with antipsychotic drugs. These studies
demonstrate that adverse effects on cardiometabolic measures, notably
BMI and insulin resistance, become apparent very soon after treatment
is initiated. Further, children and adolescents appear to be even more
sensitive to these effects than adults.
Population-wide studies are also informative. Danish data showing that
young people exposed to antipsychotics have a higher risk of diabetes,
compared with young people who had a psychiatric diagnosis but were not
exposed to antipsychotic drugs, will be presented. In addition, an Australian
comparison between a large, nationally representative sample of people
with psychosis and a general population sample shows that higher rates
of obesity and other cardiometabolic abnormalities are already evident in
people with psychosis by the age of 25 years.
Young people living with psychosis are already disadvantaged by the demands
of living with mental illness, stigma, and social factors such as
unemployment and low income. The addition of obesity, diabetes and other
comorbidities adds a further burden. The data presented highlights the need
for careful selection of antipsychotic drugs, regular monitoring of physical
health and early intervention when weight gain, glucose dysregulation, or
other cardiometabolic abnormalities are detected.

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