HPE 101 – July 2022 | Page 22

antipsychotic medication . Antipsychotics are associated with an increased prevalence of CMR , MetS and related diseases including dyslipidaemia , impaired glucose tolerance and weight gain ; 37 , 38 the greatest weight gain has been reported to
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occur during the first few months of use .
Marked differences exist in the incidence associated with different antipsychotic medication , the ( so-called ) second generation olanzapine and clozapine being associated with the highest incidence and aripiprazole , lurasidone amongst others associated with the lowest . 41 , 42 Large-scale observational studies indicate that all-cause mortality is reduced when continuous long-term antipsychotic use is maintained , this is attributed to reduced relapse rates , healthier lifestyles , less psychosisrelated cortisol increases , and increased engagement with health services . 35 , 43 , 44 Judicious prescribing can reduce excess mortality in individuals with SMI . Recent studies and evidence summaries highlight the positive impact on mortality of continuous treatment ), appropriate dose ranges , and current and long-term use .
High rates of lifestyle behaviours such as smoking exist but studies clearly and consistently demonstrate that contributory factors to morbidity and mortality extend beyond diagnosis , medication and lifestyle behaviours . 1 , 29 For example , despite the wealth of evidence that a large majority die of CVD , only one quarter receive a diagnosis for this . 35 After controlling for whether a diagnosis has been made the risk of death due to ischemic heart disease equates almost equal to that of someone in the general population . 35
A comprehensive approach is needed to improve the health and longevity of people with SMI , the greatest benefits could be achieved using a multifaceted approach which tackles individual , health system and socioeconomic factors to simultaneously address individual behaviour , health system and social factors . 1 , 29
Addressing excess morbidity and mortality Guidelines have been developed and disseminated to address this excess morbidity and mortality . These primarily target mental health , lifestyle behavioural risk factors , and screening and management for physical health . As far back as 1995 , elements of physical healthcare including CMR , MetS and related diseases were incorporated into government guidelines for SMI in parts of Australia . 45 In the UK , guidelines for schizophrenia were first published by the National Institute for Health and Care Excellence ( NICE ) in 2002 46 and included recommendations for regular physical health screening . Then , in 2004 , as a result of a US Food and Drug Administration ( FDA ) warning about the association of antipsychotics with an elevated risk of type 2 diabetes , the American Diabetes Association and the American Psychiatry Association published joint guidelines explicitly outlining the need for routine screening for diabetes for people taking antipsychotics . 47
Up-to-date versions of these guidelines recommend coordination among mental health and primary care providers , and delivery of general physical health services in mental health settings . 37 , 48 51 Manufacturers of antipsychotics include clear statements about screening and management for CMR , MetS and related diseases in their Summary of Product Characteristics ; the prescription of such medication should be in line with this legal document .
Despite the convincing evidence for the association of antipsychotic use and CMR , MetS and related diseases in people with SMI and explicit recommendations provided by guidelines , screening is often incomplete or inconsistent . 52 A review carried out in 2012 of 39 internationally published studies reported that rates of routine baseline screening were
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low ( 50 % solely for blood pressure and 59.9 % for triglycerides ), less than 50 % for cholesterol ( 41.5 %), glucose ( 44.3 %), weight ( 47.9 %) and HbA1c (< 25 %). 52 A review conducted in 2016 suggested that interventions to improve screening for obesity , hyperlipidaemia and hypertension can be effective at improving the detection of CMR , MetS and related diseases .
Delivering parity between mental and physical health The Health and Social Care Act 2012 ( UK ) set out a clear and explicitly legal responsibility for the National Health System ( NHS ) to deliver parity between mental and physical health . Further , secondary care psychiatric / mental health NHS trusts were given financial incentives to work towards meeting indicators under a Commissioning for Quality and Innovation Scheme ( CQUIN ). This included carrying out and recording screening and management for CMR , MetS and related diseases for people with SMI . Significantly , the scheme mandated communication with the patient ’ s general practitioner on discharge from secondary care . In the USA , a proposition was put forward that individuals with SMI be considered a health disparity group by the federal government . 53 This included a requirement to track health
Face-to-face interactions of pharmacists with others are important in achieving a statistically significant impact on health screening and related interventions statistics of this population and to provide more opportunities supporting these patients with their health . 53
Individuals with SMI represent a vulnerable group with multiple and substantial healthcare needs . The excess morbidity and mortality in
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