MetabolicProblemswithAtypicalAntipsychotics.ppt

What are Severe Mental Health problems? These usually include Schizophrenia and related disorders Bipolar Affective Disorder (prev known as manic-depression) Severe depression These conditions are sometimes collectively called “SMI” and tend to be the ones where are antipsychotic is prescribed Is there Accelerated mortality in SMI? Yes, there is premature mortality by 20 years on average This “mortality gap” has been increasing, as shown over…. What is the Concern Re Obesity in the Popn? In 1950 25% US adults were overweight (BMI 25) In 2005 25% were obese (BMI 30) In 1998 25% of children were overweight By 2012 Only 25% of the US population will not be overweight BMI = weight / height squared Which Risk Factors Are Important? For cardiovascular disease and general mortality… Blood pressure (BP) Smoking Inactivity (fitness) Weight / obesity Cholesterol / lipids The following are important for diabetes How Many Antipsychotics are prescribed? About 6million prescriptions in the UK per year Perhaps to 0.5 million people in the UK annually (estimated) Globally they generate about 20billion per year for the pharmaceutical industry They are prescribed for several mental health conditions About 15% are given to the under 18’s About the CATIE Study of Atypicals….. ? Non-industry sponsored. ? 1493 patients. ? 18 month double blind. ? Olanzapine, quetiapine, risperidone, ziprasidone perphenazine 74% discontinued before 18 months, median 4.6 months. Olanzapine 9.2 months Metabolic problems much greater versus general population Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353:1209–1223 But not everyone gains weight…. Weight gain begins early, typically plateaus Weight gain seen in bipolar disorder too Weight gain highest in drug-naive patients Summary of Met