Elevating the Standard of Care in the Management of Cardiometabolic Risk Factors in Patients with Mental Illness
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JUNE 2008 VOL 13 — NO 6 — SUPPL 10 CNS SPECTRUMS® THE INTERNATIONAL JOURNAL OF NEUROPSYCHIATRIC MEDICINE CLINICAL INFORMATION SUPPLEMENT ELEVATING THE STANDARD OF CARE IN THE MANAGEMENT OF CARDIOMETABOLIC RISK FACTORS IN PATIENTS WITH MENTAL ILLNESS AUTHORS John W. Newcomer, MD, Henry A. Nasrallah, MD, Roger S. McIntyre, MD, Charles H. Hennekens, MD, DrPH, Suzanne Vogel-Scibilia, MD FOCUS POINTS • Serious mental illness is associated with a significantly reduced life expectancy that is mainly attributable to the increased risk for cardiovascular disease (CVD) in this population. • Some antipsychotics used in the treatment of schizophrenia and bipolar disorder can increase patients’ risks for diabetes and CVD. • Modest changes in key CVD risk factors can have a significant impact on the long-term health of people with and without mental illness. • Comprehensive treatment plans for patients with serious mental illness include screening for metabolic abnormalities as well as interventions that will help reduce their risk for CVD. ABSTRACT Major mental illness, including schizophrenia and bipolar disorder, is associated with increased mortality, primarily due to increased rates of cardiovascular disease (CVD). The risk for CVD, including coronary heart disease and cerebrovascular disease, in this population can be influenced by health systems (ie, access to health care) as well as psychobehavioral (eg, smoking, poor diet, sedentary lifestyle), psychobiological (eg, cortisol dysregulation), and treatment-associated factors (eg, adverse metabolic effects of some medications used to manage psychiatric symptoms). Despite the existence of guidelines for metabolic monitoring and management of CVD risk factors in patients with serious mental illness, uptake and translation of these guidelines into routine care has been limited. This Clinical Information Supplement reviews metabolic risks in patients with schizophrenia and bipolar disorder and discusses ways to overcome obstacles to screening, monitoring, and reducing cardiovascular risk factors in patients with seri- ous mental illness as recommended in consensus guidelines. The goal of recovery for people with severe mental illness needs to combine the concept of general medical health with that of the healthy mind by including screening, education, and intervention for CVD as part of the treatment model for people with persistent mental illness. DownloadedIndex from Medicus https://www.cambridge.org/core citation: CNS. IP address:Spectr 170.106.202.58 , on 29 Sep 2021 at 07:08:56, subject to the Cambridge Core termswww.cnsspectrums.com of use, available at https://www.cambridge.org/core/terms© MBL Communications,. https://doi.org/10.1017/S1092852900003060 Inc. CLINICAL INFORMATION SUPPLEMENT An expert panel review of clinical challenges in psychiatry EDITORS EDITORIAL ADVISORY BOARD EDITOR Herbert Y. Meltzer, MD Eric Hollander, MD NEUROLOGISTS Vanderbilt University Medical Center Mount Sinai School of Medicine Mitchell F. Brin, MD Nashville, TN University of California, Irvine New York, NY Stuart A. Montgomery, MD Irvine, CA St. Mary’s Hospital Medical School INTERNATIONAL EDITOR Jeffrey L. Cummings, MD London, United Kingdom University of California, Los Angeles Joseph Zohar, MD Charles B. Nemeroff, MD, PhD Chaim Sheba Medical Center Los Angeles, CA Emory University School of Medicine Tel-Hashomer, Israel Jerome Engel, Jr., MD, PhD Atlanta, GA University of California, Los Angeles ASSOCIATE INTERNATIONAL EDITORS Humberto Nicolini, MD, PhD Los Angeles, CA National Mexican Institute of Psychiatry EUROPE Mark S. George, MD Mexico City, Mexico Medical University of South Carolina Donatella Marazziti, MD Stefano Pallanti, MD, PhD University of Pisa Charleston, SC University of Florence Pisa, Italy Richard B. Lipton, MD Florence, Italy Albert Einstein College of Medicine Katharine Phillips, MD MID-ATLANTIC Bronx, NY Brown Medical School Dan J. Stein, MD, PhD C. Warren Olanow, MD, FRCPC Providence, RI University of Cape Town Mount Sinai School of Medicine Cape Town, South Africa Harold A. Pincus, MD New York, NY Columbia University Steven George Pavlakis, MD New York, NY ASIA Maimonides Medical Center Shigeto Yamawaki, MD, PhD Brooklyn, NY Scott L. Rauch, MD Hiroshima University School Massachusetts General Hospital Stephen D. Silberstein, MD, FACP Charlestown, MA of Medicine Hiroshima, Japan Thomas Jefferson University Alan F. Schatzberg, MD Philadelphia, PA Stanford University School of Medicine Michael Trimble, MD, FRCP, FRPsych Stanford, CA CONTRIBUTING WRITERS National Hospital for Neurology Charles H. Hennekens, MD, DrPH Thomas E. Schlaepfer, MD and Neurosurgery University of Bonn Roger S. McIntyre, MD London, United Kingdom Henry A. Nasrallah, MD Bonn, Germany John W. Newcomer, MD Stephen M. Stahl, MD, PhD Suzanne Vogel-Scibilia, MD PSYCHIATRISTS University of California, San Diego Dennis S. Charney, MD La Jolla, CA FIELD EDITOR Mount Sinai School of Medicine Norman Sussman, MD Michael Trimble, MD, FRCP, FRPsych New York, NY New York University Medical School Dwight L. Evans, MD New York, NY COLUMNISTS University of Pennsylvania Michael E. Thase, MD Uriel Halbriech, MD Philadelphia, PA University of Pennsylvania School of Medicine Stefano Pallanti, MD, PhD Siegfried Kasper, MD Philadelphia, PA Thomas E. Schlaepfer, MD University of Vienna Madhukar H. Trivedi, MD Stephen M. Stahl, MD, PhD Vienna, Austria Dan J. Stein, MD, PhD University of Texas Southwestern Medical Center Martin B. Keller, MD Dallas, TX Brown Medical School Karen Dineen Wagner, MD, PhD Providence, RI The University of Texas Medical Branch Lorrin M. Koran, MD Galveston, TX Stanford University School of Medicine Herman G.M. Westenberg, MD Stanford, CA University Hospital Utrecht Yves Lecrubier, MD Utrecht, The Netherlands Hôpital de la Salpêtrière Stuart C. Yudofsky, MD Paris, France Baylor College of Medicine Houston, TX PUBLICATION STAFF CEO & PUBLISHER ASSISTANT EDITOR STAFF ACCOUNTANT Darren L. Brodeur Carlos Perkins, Jr. Diana Tan VP, MANAGING EDITOR SENIOR ACQUISITIONS EDITOR ACCOUNTING INTERN Christopher Naccari Lisa Arrington Stephanie Spano VP, SENIOR EDITOR ACQUISITIONS EDITOR SALES & EVENT COORDINATOR Deborah Hughes Virginia Jackson Kimberly Schneider VP, HUMAN RESOURCES EDITORIAL INTERNS OFFICE MANAGER Kimberly A. Brodeur Jaime Cunningham Ronald Means Michelisa Lanche SENIOR GLOBAL RECEPTIONISTS ACCOUNT DIRECTOR CME DEVELOPMENT MANAGER Kimberly Forbes Richard Ehrlich Shelley Wong Lauren Webb ACCOUNT MANAGER ASSISTANT—ENDURING MATERIALS INFORMATION TECHNOLOGY Lisa Pisicchio Sonny Santana Clint Bagwell Consulting SENIOR EDITORS ART DIRECTOR WEB INTERN Peter Cook—Psychiatry Weekly Derek Oscarson Adam Schwartz José Ralat—CNS Spectrums GRAPHIC DESIGNER CORPORATION COUNSEL SENIOR ASSOCIATE EDITOR Michael J. Vodilko Lawrence Ross, Esq. Dena Croog—Primary Psychiatry Bressler, Amery, and Ross CHIEF FINANCIAL OFFICER ASSOCIATE EDITORS John Spano Lonnie Stoltzfoos—Psychiatry Weekly Rebecca Zerzan "Translating Research Advances Into Clinical Practice" The Largest Peer Reviewed Psychiatric Journal in the Nation DownloadedCNS from Spectr https://www.cambridge.org/core 13:6 (Suppl 10) ©MBL. IP address: Communications, 170.106.202.58, on 29 Inc. Sep 2021 at 07:08:56, subject to the Cambridge Core terms of use, available June at 2008 https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1092852900003060 2.