VOLUME 9 NUMBER 3 • SEPTEMBER 2012
111
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
and mental illness, however, require close collaboration between
mental and physical health services.
Attention must also be paid to preventing diabetes; recent trials
have shown that lifestyle intervention programmes involving dietary
modification, weight-loss and increased physical activity reduce the
incidence of type 2 diabetes. As these programmes share many
features with lifestyle weight-loss programmes used in people with
severe mental illness, it is hoped that the programmes may also
lead to diabetes prevention although this has not been formally
assessed. Metformin treatment may also be considered.
4
Hypertension
The management of hypertension in severe mental illness should
follow the same treatment algorithm as in the general population,
with target blood pressure levels of < 140/90 mmHg being recom-
mended. Patients should be advised to reduce smoking and salt
intake. European and UK guidelines emphasise the need to choose
antihypertensive agents best suited to the individual patient’s needs
as the achieved blood pressure is more important than the agent
used to achieve it.
Conclusion
The increased rates of diabetes and cardiovascular disease in people
with severe mental illness provide a clinical imperative to screen and
manage cardiovascular disease using a systematic approach. In the
past, the physical health needs of people with severe mental illness
have largely been ignored, creating significant health inequalities.
Although there are additional challenges in the treatment of people
with severe mental illness, doing the simple things well is likely to
have a significant impact on cardiovascular disease in severe mental
illness.
Conflicts of interest
Professor Holt has undertaken lectures for Astra Zeneca, Bristol-
Myers Squibb, Eli Lilly, GlaxoSmithKline, Novo Nordisk and Otsuka
Pharmaceuticals. He has served on advisory boards for Astra Zeneca,
Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline and Novo Nordisk.
He has received funding to attend conferences from Astra Zeneca,
Eli Lilly, GlaxoSmithKline, Novo Nordisk.
References
Brown S, Kim M, Mitchell C, Inskip H. Twenty-five year mortality of a community
1.
cohort with schizophrenia.
Br J Psychiatry
2010;
196
: 116–21.
Buhagiar K, Parsonage L, Osborn DP. Physical health behaviours and health locus
2.
of control in people with schizophrenia-spectrum disorder and bipolar disorder: a
crosssectional comparative study with people with non-psychotic mental illness.
BMC Psychiatry
2011;
11
: 104.
Osborn DP, Levy G, Nazareth I, Petersen I, Islam A, King MB. Relative risk of
3.
cardiovascular and cancer mortality in people with severe mental illness from
the United Kingdom's General Practice Research Database.
Arch Gen Psychiatry
2007;
64
: 242–9.
De Hert M, Dekker JM, Wood D, Kahl KG, Holt RI, Moller HJ. Cardiovascular
4.
disease and diabetes in people with severe mental illness position statement from
the European Psychiatric Association (EPA), supported by the European Association
for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC).
Eur Psychiatry
2009;
24
: 412–24.
McEvoy JP, Meyer JM, Goff DC,
5.
et al
.
Prevalence of the metabolic syndrome in
patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials
of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with
national estimates from NHANES III.
Schizophr Res
2005;
80
: 19–32.
Holt RI, Peveler RC. Obesity, serious mental illness and antipsychotic drugs.
6.
Diabetes Obes Metab
2009;
11
: 665–79.
Osborn DP, Wright CA, Levy G, King MB, Deo R, Nazareth I. Relative risk of
7.
diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people
with severe mental illnesses: systematic review and metaanalysis.
BMC Psychiatry
2008;
8
: 84.
Holt RI, Peveler RC. Antipsychotic drugs and diabetes-an application of the Austin
8.
Bradford Hill criteria.
Diabetologia
2006;
49
: 1467–76.
Tiihonen J, Lonnqvist J, Wahlbeck K
9.
et al
. 11-
year follow-up of mortality in
patients with schizophrenia: a population-based cohort study (FIN11 study).
Lancet
2009;
374
: 620–7.
National Collaborating Centre for Mental Health. The NICE guideline on core
10.
interventions in the treatment and management of schizophrenia in adults in
primary and secondary care CG82. London: The British Psychological Society and
The Royal College of Psychiatrists; 2010.
NHS Employers. Quality and Outcomes Framework guidance for GMS contract
11.
2011/12:
Delivering investment in general practice.
org/Aboutus/Publications/Documents/QOF_guidance_GMS_contract_2011_12.
pdf. 2011. Accessed 8-11-0011.
Citrome L, Yeomans D. Do guidelines for severe mental illness promote physical
12.
health and well-being?
J Psychopharmacol
2005;
19
(6
Suppl): 102–09.
Disability Rights Commission. Equal Treatment: Closing the gap. A formal
13.
investigation into physical health inequalities experienced by people with learning
difficulties and mental health problems. London: Disability Rights Commission;
2006.
Holt RI, Abdelrahman T, HirschM,
14.
et al
.
The prevalence of undiagnosed metabolic
abnormalities in people with serious mental illness.
J Psychopharmacol
2010;
24
: 867–73.
Barnes TR, Paton C, Cavanagh MR, Hancock E, Taylor DM. A UK audit of screening
15.
for the metabolic side effects of antipsychotics in community patients.
Schizophr
Bull
2007;
33
: 1397–403.
Osborn DP, King MB, Nazareth I. Participation in screening for cardiovascular risk
16.
by people with schizophrenia or similar mental illnesses: cross sectional study in
general practice.
Br Med J
2003;
326
: 1122–3.
Baptista T, ElFakih Y, Uzcategui E
17.
et al
.
Pharmacological management of atypical
antipsychotic-induced weight gain.
CNS Drugs
2008;
22
: 477–95.
Alvarez-Jimenez M, Hetrick SE, Gonzalez-Blanch C, Gleeson JF, McGorry PD. Non-
18.
pharmacological management of antipsychotic-induced weight gain: systematic
review and meta-analysis of randomised controlled trials.
Br J Psychiatry
2008;
193
:
101–07.
Holt RI, Pendlebury J, Wildgust HJ, Bushe CJ. Intentional weight loss in overweight
19.
and obese patients with severe mental illness: 8-year experience of a behavioral
treatment program.
J Clin Psychiatry
2010;
7
: 800–05.
Hanssens L, De Hert M, Kalnicka D,
20.
et al
.
Pharmacological treatment of severe dyslipi-
daemia in patients with schizophrenia.
Int Clin Psychopharmacol
2007;
22
: 43–9.
