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![Page 1: Body and Mind: Metabolic Syndrome and Mental Health A workshop to discuss the management of metabolic issues in people with mental illness.](https://reader033.fdocuments.net/reader033/viewer/2022061306/551468aa550346414e8b5c96/html5/thumbnails/1.jpg)
Body and Mind: Metabolic Syndrome and Mental Health
A workshop to discuss the management of metabolic issues in people with mental illness
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Overview
• A meeting was convened by the World Federation for Mental Health in September 2004 to discuss mental illness and metabolic syndrome
– Attended by ten physicians, consumers and caregiver groups from around the world
– Output: “Advancing the treatment of people with mental illness: a call-to-action in the management of metabolic issues”, published in Journal of Clinical Psychiatry in June 2005
• Aim of today’s workshop
– Summarise the findings published in the JCP article
– Discuss practical implementation of the recommendations
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What is metabolic syndrome?
• Metabolic syndrome:
– a complex disorder consisting of multiple risk factors that promotes cardiovascular disease and overall mortality and morbidity1,2
– Obesity and insulin resistance are two of the most important causative factors3
– Components may have genetic or environmental basis
Obesity
HypertensionImpaired glucose tolerance
Dyslipidemia
1Ninomiya JK et al. Circulation 2004;109:42-46; 2Malik S et al. Circulation 2004;110:1245-1250;3Grundy SM et al. Circulation 2005;112(17):e285-90
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ATP III definition: the metabolic syndrome
• 3 or more risk factors required to meet the definition
Factor Measurement
Obesity
• Waist circumference
– Male– Female
>102cm (>40in)
>88cm (>35 in)
Dyslipidaemia
• Triglycerides
• HDL cholesterol
– Male– Female
150 mg/dL (1.7mmol/L)
<40mg/dL (<1.0mmol/L)
<50mg/dL (<1.2mmol/L)
Hypertension 130/85mmHg
Fasting glucose 100mg/dL (5.5mmol/L)
ATP III = National Cholesterol Education Program Adult Treatment Panel IIIJAMA 2001; 285: 2486-2497
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Country Prevalence of metabolic syndrome
USA 20 – 30%1-3
Japan 11.0%4
France 12.4%5
Germany 19.8%6
Italy 14.4%7
Spain 19.5%8
UK 19.6%6
Greece 20%9
Urban Indians 30 – 40%10,11
1Ford ES et al. Diabetes Care 2004;27:2444-2449; 2Park YW et al. Arch Intern Med 2003;163:427-436; 3Haffner S et al. Circulation 2003;108:1541-1545; 4AnuurAD e ET AL. Journal of Occupational Health 2003;45(6):335-43; 5Balkau B et al. Diabetes and Metabolism 2003;29(5):526-32; 6Sattar N et al. Circulation 2003:108(4):414-9; 7Bonora E et al. Int J Obes Relat Metab Disord 2003;27:1283-1289; 8Alverez Leon EE et al. Medicina Clinica 2003;120(5):172-4; 9Panagiotakos DB et al. Am Heart J 2004;147:106-112; 10Gupta R et al. Int J Cardiol 2004;97:257-261; 11Ramachandran A et al. Diabetes Res Clin Prac 2003;60:199-204
Prevalence of metabolic syndrome in the general population
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Metabolic syndrome and mental illness
• Metabolic syndrome may be more prevalent in people with mental illness1
– Their lifestyle factors may contribute to the development of metabolic syndrome2,3
• People with mental illness have a reduced life expectancy compared to the general population
– Metabolic syndrome (especially CVD) contributes to this4
• Poor diet
• Lack of exercise
• Smoking
• Stress
• Medication that causes weight gain
• Inadequate self-care
• Adherence to prescribed medication
• Financial hardship
• Poor self-esteem and lack of motivation
• Limited availability and co-ordination of medical care
1Holt RI. Diabet Med 2004;21:515-523; 2McCreadie RF et al. Br J Psychiatry 2003;183:534-539; 3Kumar CT. Br J Psychiatry 2004;184:541; 4Marder SR et al. Am J of Psy 2004:161(8);1334-49
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Recommendations for metabolic disorder management in people with mental illness
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Issues
• Healthcare professionals (HCPs) need to be fully informed of the increased risk of metabolic disorders and need for intensive monitoring
• Collaboration required between HCPs, caregivers and individuals concerned
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Who should manage physical health monitoring?
• Will vary from country to country and from urban to rural setting
• Ideally, physical health monitoring should be incorporated into community mental health services
– Mental health clinics may be poorly equipped
– Psychiatrists may lack familiarity with metabolic monitoring
• However, PCPs may be ideally placed
– Oversee patients’ complete healthcare programmes
– Long-term relationship with person and family
– Co-ordinate general and mental health services
– But, PCPs often have little specialised training in mental health
Conclusion: the prescriber of the medication for the mental disorder should take responsibility for ensuring that monitoring occurs
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What needs to be monitored?
Metabolic risk factor How to monitor When to monitor1
Weight (BMI / waist circumference)
Body Mass Index 1 – 3 months
Insulin resistance Fasting blood glucose test
HbA1c test
4 months – 1 year
Blood pressure Standard method 6 weeks – every visit
Lipid profile Blood sample (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides)
6 months – 2 years
1Marder SR et al. Am J Psychiatry 2004;161(8):1334-1349
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What should be done when evidence of metabolic disorders is identified?
• Inform concerned individual of their condition and provide support in making lifestyle changes
• Refer for treatment to appropriate HCP
– Impaired glucose tolerance / diabetes
– Elevated blood pressure
– Dyslipidaemia
• Review antipsychotic medication
– May be associated with weight gain and impaired glucose tolerance1
• Risk / benefit (risk factors vs. efficacy) differs from person to person
1Allison DB et al. Am J Psychiatry 1999;156:1686-96
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How can people with mental illness be supported in making lifestyle changes?
• HCPs need to provide significant support– Achieving and maintaining weight loss is more likely to be successful when
there is a physician-patient partnership1
– Referral of consumers, when relevant, to• Nutritionist or dietician• Substance abuse professionals2
– Motivational interviewing may be helpful when lifestyle changes are being made
• Family members / caregivers– Involve where relevant, encourage participation in healthy diet and exercise
and provide information
1Hill JO et al. Obes Res 2002;10(suppl 2):124S-130S; 2Steinberg ML et al. Consult Clin Psychol 2004;72:723-728
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Conclusions
• People with mental illness are at particular risk of developing the components of metabolic syndrome
• Prevention of metabolic disorders is key to ensuring the physical health of people with mental illness
• Regular and comprehensive monitoring is necessary to ensure proper risk management
• Greater overall awareness of metabolic disorders in people with mental illness within the broad medical community is urgently needed
• Treatment of people with mental illness is a collaborative effort between clinicians, the person involved and their family / caregivers
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Discussion
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Discussion
Primary Care Practitioners
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Goals of discussion
• Explore the importance of physical health monitoring in people with mental illness, and how and when monitoring should take place
• Develop awareness of key considerations when working with people with mental illness
• Discuss tools to facilitate best practice in recording and sharing important information regarding the mental and physical health of people with mental illness
• Discuss a best practice checklist for working with people with mental illness
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Discussion topics
• Monitoring metabolic syndrome risk factors
– How to monitor
– Frequency of monitoring
• Encouraging self-monitoring
– Obesity – weight change of 3-5kg
– Blood sugar – increased thirst / urination
• Encouraging healthy behaviour
– Healthy eating
– Increased physical activity
– Quit / cut down on smoking
– Decrease alcohol consumption
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Discussion topics (cont.)
• Considerations for people with mental illness
– Mental health history
– Personal stressors / triggers
– Unusual behaviours to watch out for
– Other HCPs seen by the individual
• Involve families and caregivers
– Establish source of support
– Build a familiar and trusting relationship with them
• Working with mental health specialists
– Sharing of information
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Discussion
Mental Health Practitioners
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Goals of discussion
• Share experiences of advising people with mental illness on physical health matters.
• Develop awareness of how to listen attentively to people with mental illness and assist them in developing their own healthy living plans
• Discuss tools to facilitate and encourage these individuals to take more responsibility for their own health
• Discuss a best practice checklist for discussing metabolic syndrome with people with mental illness
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Discussion topics
• Healthy living curve
• Identifying unhealthy behaviour
– Diet / exercise / smoking
• Healthy living pros and cons
• Developing a healthy living plan
– Diet / exercise / smoking / alcohol / self-help groups / supportive relationships / medication
• Implementing a healthy living plan
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Discussion topics (cont.)
• Supportive people
– Family members / friends / other HCPs to help put healthy strategies into action
• Self-monitoring
– Obesity / blood sugar
• Medication review
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Discussion
Mental Health Consumer and Family
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Goals of discussion
• Explain how to develop a healthy living plan, and how to talk to physicians and mental health practitioners about metabolic syndrome
• Empower you/your relative to take responsibility for physical health and develop a healthy living plan
• Discuss tools to facilitate and enable you/your relative to become more involved in decisions about mental and physical health
• Discuss a checklist of suggested activities to ensure physical health and help prevent metabolic syndrome
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Discussion topics
• Asking your doctor for physical health monitoring
– Weight / blood sugar / blood pressure / fats in blood
• Talking to your doctor
– Clarify what you want to discuss
• Self-monitoring
– Weight / blood sugar
• Identifying unhealthy behaviour
– Diet / exercise / smoking
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Discussion topics (cont.)
• Identifying personal goals
• Healthy living plan
– Diet / exercise / smoking / drinking / self-help group / supportive relationships / medication
• Getting support for a healthy living plan
– Family / friends / HCPs
• Medication review