Metabolic Disorder Syndrome in People with Severe Mental Illnesses
Introduction
Metabolic syndrome is a condition that comprises several disorders like obesity, glucose intolerance, insulin resistance, dyslipidemias, hypotension and cardiovascular disease. Metabolic syndrome is largely associated with mental illnesses. Schizophrenics have been the main targets when assessing for this condition due to their likelihood of living unhealthy lifestyles (one of the risk factors). Use of certain antipsychotic medications could also predispose the individual to metabolic disorders. It is therefore thought that metabolic syndrome is an interaction of socioeconomic status, lifestyle, genetic factors and use of neuroleptics (Ganguli et al., 2011). This paper therefore talks about metabolic disorders in people with severe mental illnesses, health trends of schizophrenics and pathophysiology of the conditions.
Population of Interest
Antipsychotics vary in the ability to induce weight gain with some having greater propensity than others. Patients on neuroleptics have been found to have more abdominal fat deposition than normal members of the society. Such increase in weight could then result into other conditions such as diabetes, hypotension and other cardiovascular conditions. However, some conditions like type-2 diabetes may be brought about by the illness itself. For instance, it has been found that unaffected relatives of schizophrenics record high rates of the illness. This is a clear indicator of genetic relationships between these conditions (Thakore et al. 2005). [“Write my essay for me?” Get help here.]
Health Trends in People with Schizophrenia
Mortality rates in people with schizophrenia have been on the rise despite improvements in the healthcare. It is estimated that mortality rates in schizophrenia patients is 2-3 times higher than for the general population. Natural deaths and cardiovascular diseases were the main cause of these mortalities. Suicide and unspecified violence also contributed. All these were attributed to the unhealthy lifestyles adopted by these patients due to the illness (Osby et al., 2000).
Epidemiology
There has been varying information on the epidemiologic information about metabolic disorders in patients with severe mental disorders. Prevalence rates for schizophrenic patients under medication ranges from 11 % to 69 % while that for patients not taking medications being 4 % to 26 %. Generally metabolic disorders are more prevalent in schizophrenic patients than as observed in the general population. Increase in age also increases the prevalence of metabolic disorders. However, there is no association between the prevalence and demographic and clinical variables (Malhotra et al., 2013).
Current trends
Antipsychotic treatment is crucial in reducing mortalities resulting from schizophrenia. It has been observed that, though mortalities resulting from schizophrenia are high, there are reduced cases of mortality with antipsychotic treatment rather than with no treatment. Atypical antipsychotics also do not increase cardiovascular mortality and morbidity as is the case with conventional (Bushe et al., 2010).
Despite improvements achieved through the use of atypical antipsychotics in schizophrenia patients, weight gain, high serum prolactin among other side effects has been noted. Insulin insensitivity and type-2 diabetes have also been largely associated with the use of atypical antipsychotics. It has however been noted that patients that use atypical antipsychotics have lower risks of developing metabolic disorders than those using conventional antipsychotics (Ollendorf et al., 2004).
Studies show that metabolic disorders are likely to develop in young people suffering from schizophrenia and on antipsychotics treatment. Higher prevalence for metabolic disorders is seen from ages 15-25 years and continues to increase with age. This striking finding also correlates with that in the normal population since increased prevalence for metabolic disorders is also observed in the general population (De Hert et al., 2006).
Population health considerations
Schizophrenic patients experience high rates of mortality and morbidity as compared to the general population. These patients have a shorter lifespan by approximately 20 years than people not suffering from the disease. This is mainly due to suicide, cancer and cardiovascular diseases resulting from metabolic disorders. It therefore becomes the responsibility of clinicians to be keen and single out any risks for cardiovascular diseases like abdominal obesity and hypertension. Combination of these two or more such risks further predisposes the individual to cardiovascular diseases.[Need an essay writing service? Find help here.]
Lifestyle psychiatrics should have vast knowledge on the metabolic risks associated with treatments for schizophrenics before initiating any treatment. Establishing a risk profile based on the genetic, lifestyle and medical factors is very crucial for before initializing treatment procedures for these patients. Low risk strategies such as encouraging healthy lifestyles, frequent checkup and monitoring weight, glucose and lipid levels is highly recommended after every treatment (Van Gal et al. 2006).
Pathophysiology and Mechanisms of Metabolic Disorders and Schizophrenia
Adverse effects of antipsychotic medications are largely associated with metabolic disorder syndrome. It has also been found that some of the metabolic disorders like insulin intolerance and diabetes appear at early stages of the disease when even no medication has been started. Despite the fact that all the risk factors for metabolic disorders are known, it is difficult to control them all.
The etiology and pathophysiology of it is not well understood with majority of the hypotheses revolving around lifestyle and dietary habits, antipsychotic drug adverse effects and alterations of hypothalamic pituitary-adrenal axis. Unhealthy dietary habits facilitate obesity which increases the risk for developing cardiovascular diseases; antipsychotic drugs interfere with lipid and carbohydrate metabolism resulting into obesity and diabetes while interference with the hypothalamic pituitary-adrenal axis causing obesity of the trunk.[Click Essay Writer to order your essay]
Pathophysiological Consequences
Metabolic disorder syndrome precipitates cardiovascular diseases through various mechanisms. To start with, reduced insulin sensitivity and high blood sugar levels increase the chance for diabetes. More so this leads to type-2 diabetes which further increases the chances for cardiovascular diseases like hypertension. Obesity on the other hand leads to increased lipid levels and could cause arteriosclerosis that may lead to fatal heart diseases like hypertension or heart attack.
Role of Advance Practice Nurse
The increased prevalence of metabolic syndrome is worrisome for medical providers in general and more so for providers who treat at-risk populations such as persons with SMI. The treatment of SMI appears to be primarily treated with pharmacological treatments. The advanced practice nurse (APN) must be adept pharmacotherapeutics with an expert understanding of the medications prescribed to treat the illnesses in this population. The APN must be proficient in interventions to manage metabolic syndrome. Interventions to include lifestyle modifications and use of metabolic agents and switching medications as needed. Lastly, the APN is well-qualified to lead research into these phenomena and add to the current knowledge base (Mwebe et al. 2016).
References
Bushe, C. J., Taylor, M., & Haukka, J. (2010). Review: Mortality in schizophrenia: a measurable clinical endpoint. Journal of psychopharmacology, 24(4 suppl), 17-25.
De Hert, M., Van Winkel, R., Van Eyck, D., Hanssens, L., Wampers, M., Scheen, A., & Peuskens, J. (2006). Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study. Clinical Practice and Epidemiology in Mental Health, 2(1), 1.
Ganguli, R., & Strassnig, M. (2011). Prevention of metabolic syndrome in serious mental illness. Psychiatric Clinics of North America, 34(1), 109-125.
Malhotra, N., Grover, S., Chakrabarti, S., & Kulhara, P. (2013). Metabolic syndrome in schizophrenia. Indian Journal of Psychological Medicine, 35(3), 227–240.
Mwebe, H. (2016). Physical health monitoring in mental health settings: A study exploring mental health nurses’ views of their role. Journal of Clinical Nursing.
Ollendorf, D. A., Joyce, A. T., & Rucker, M. (2004). Rate of new-onset diabetes among patients treated with atypical or conventional antipsychotic medications for schizophrenia. Med Gen Med, 6(5).
Ösby, U., Correia, N., Brandt, L., Ekbom, A., & Sparén, P. (2000). Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. Bmj, 321(7259), 483-484.
Thakore, J. H. (2005). Metabolic syndrome and schizophrenia. The British Journal of Psychiatry, 186(6), 455-456.
Van Gaal, L. F. (2006). Long-term health considerations in schizophrenia: metabolic effects and the role of abdominal adiposity. European neuropsychopharmacology, 16, S142-S148.
