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Cardiometabolic Risk and Monitoring in Psychiatric Disorders

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Abstract

Severe psychiatric disorders are associated with a mortality gap of 20–30 years, attributable to premature cardiac disease and diabetes mellitus. Both are substantially related to obesity and its metabolic complications, which occur following the initiation of psychotropic medications, particularly antipsychotics.

The risk of incident heart disease in people with severe mental illness is 1.6–2.2 times higher, with higher risk in men. The excess risk is related to higher rates of traditional and modifiable cardiovascular risk factors, including higher rates of smoking, diabetes, hyperlipidaemia, hypertension and obesity, with poorer diet and greater sedentariness. This chapter reviews the major studies of cardiac disease in people with severe mental illness and discusses their strengths and limitations.

Diabetes risk is also increased in severe mental illness, related to greater rates of obesity, sedentariness and poor diet. Exposure to antidepressant medications and antipsychotic medications appears to increase diabetes risk 1.4- to 1.6-fold overall, though there is evidence that some medications have a much stronger association with incident diabetes. The major studies pertaining to diabetes risk in people with severe mental illness are discussed.

Strategies for detection of weight gain and metabolic decline are discussed and screening algorithms presented. Early detection of change in traditional and modifiable cardiometabolic risk factors is essential for early intervention, for the preservation of physical health in people with severe mental illness. Lifestyle intervention at psychotropic medication initiation prevents weight gain and cardiometabolic decline. This will translate to abbreviation of the premature cardiovascular mortality in people with severe mental illness, as has already occurred in the general population.

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Authors and Affiliations

  1. Department of Endocrinology, St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Sydney, Australia

    Katherine Samaras MBBS, PhD, FRACP

  2. Diabetes and Obesity Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, Sydney, Australia

    Katherine Samaras MBBS, PhD, FRACP

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  1. Katherine Samaras MBBS, PhD, FRACP
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Correspondence to Katherine Samaras MBBS, PhD, FRACP .

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  1. Discipline of Psychiatry, School of Medicine , University of Adelaide, Adelaide, Australia

    Bernhard T. Baune

  2. The Freemason's Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Phillip J. Tully

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Samaras, K. (2016). Cardiometabolic Risk and Monitoring in Psychiatric Disorders. In: Baune, B., Tully, P. (eds) Cardiovascular Diseases and Depression. Springer, Cham. https://doi.org/10.1007/978-3-319-32480-7_18

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