Physical Health Management: Why it s important for adolescents and young adults in mental health services

Transcription

1 Physical Health Management: Why it s important for adolescents and young adults in mental health services Early Intervention Service Wellington Lauren Heath and Erin Dawson

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3 Introduction Second generation antipsychotic (SGAs) Research Shows EIS Client experiences Physical Health Guidelines Challenges Interventions

4 Why is metabolic monitoring x important? METABOLIC SYNDROME : Weight gain, dyslipidemia, hypertension, insulin resistance Cardiovascular disease, Diabetes Reduced life expectancy- 20%

5 Metabolic Highway (Stahl) Diabetes RIP Cardiovascular events Insulin resistance Prediabetes Appetite Obesity Dyslipidaemia

6 Why We Should Monitor? Mental Health clients tend to : Be less active Have a poor diet Come from a lower socio-economic status Smoke Less likely to access primary health

7 SGA HYPOTHESIS: Why weight gain???????????????????????????????

8 SGA HYPOTHESIS: Why weight gain??????????????????????????????? Histamine and Serotonin receptors appear to be involved

9 SGA HYPOTHESIS: Why weight gain??????????????????????????????? Histamine receptors in the hypothalamus- blocked leading to increased appetite Serotonin receptors- blocked in the gut, leading to loss of appetite suppression and inability to feel full i.e. Clozapine and olanzapine = highest incidence of weight gain of all SGAs.

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11 EIS Client Experiences

12 Client Experience #1 22 year old Male of NZ descent. Olanzapine 10mg and Sodium Valporate 100mg Baseline Weight 61 kilograms. No baseline lipids done on ward. Two months later weight 70.9 kgs, 9.9 kgs. Cholesterol 5.5mmol/l, Triglyceride 1.7mmol/l, Cholesterol Ratio 3.8.

13 Client Experience #2 21 year old male Tokelauan descent. Olanzapine 40mg Baseline weight 133.6kgs, waist 130cm, BMI 40.1 Baseline Cholesterol 5.6, Triglycerides 1.06, chol ratio Blood Glucose 5.2 Current weight kg, 19kgs, BMI 46, Waist cms 139cm. Cholesterol 5.5, Triglycerides 0.6, Cholesterol Ratio 2.6, Blood Glucose 6.1

14 Wellington EIS: Physical Health Management Guidelines 2011 Baseline measurements Client s height, weight, waist circumference, BMI and BP, pulse Blood test baseline: fasting Glucose/HbA1c, electrolytes, liver function tests, thyroid function tests, fasting lipid panel, prolactin

15 Wellington EIS: Physical Health Management Guidelines 2011 At each monthly visit, then 3 monthly Weight, height, waist circumference, BP, BMI If weight gain or metabolic abnormalities: dietician referral, increase activity? Metformin? 3 monthly reviews at MDT 6 monthly audit- ongoing assessment

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17 CCDHB Metabolic Monitoring: Primary/Secondary o Primary sector already screening clients. Secondary sector - slower uptake. Baseline screening Monthly for first three months for Olanzapine and Clozapine. Then quarterly for first year. All other Antipsychotics baseline screening then yearly.

18 Interventions -

19 Interventions Referral to dietitican Increase activity and groups Education re diet and healthy lifestyle Smoking cessation Change of Antipsychotic Medication. Metformin

20 Challenges Who does the monitoring? Staff motivated and committed to metabolic monitoring Engaging clients Decreased self confidence and being supported to try new things Time and transport

21 Successes for clients Clients independently playing sports and increasing activity Increased motivation and willingness Breaking the cycle of weight gain Persistence and Determination

22 Take home messages Someone on the team needs to take ownership of Metabolic Monitoring Its important to look for dyslipidemia, alongside weight, BMI and waist circumference. Assertive Follow up may lead to young people avoiding the metabolic highway.

23 References A New Zealand Mental health metabolic Working Group Initiative, proudly supported by Jannsen-Cilag Limited New Zealand. First edition published Second edition published Hetrick, S., Alvarez-Jimenez,M., Parker, A., Hughes, F., Willet, M., Morley, K., Fraser, R., McGorry, P.D, Thompson, A. (2010). Promoting physical health in youth mental health Services: Ensuring Routine monitoring of Weight and Metabolic Indices in a first Episode Psychosis Clinic. Australasian Psychiatry. 18: Metabolic Monitoring for people receiving Antipsychotic Therapy,, Capital Coast District Health Board, Wellington. Final Draft pending approval, March Meyer, J. M. & Stahl, S. M. (2009). The metabolic syndrome and schizophrenia. Acta Psychiatr Scand: 119: 4 14 National Institute for Health and Clinical Excellence. Guidelines for Schizophrenia (Clinical Guideline 82). NICE, 2006 ( Stahl, S.M., Mignon, L., Meyer, J.M. (2009). Which comes first: atypical antipsychotic treatment or cardio metabolic risk? Acta Psychiatr Scand: 119: Wu. R.R., Zhao, J.P., Guo, X.F., He, Y.Q., Fang, M.S., & Guo, W.B, et al. (2008a). Metformin addition attenuates olanzapine-induced weight gain in drug-naïve first-episode schizophrenia patients: a double-blind, placebo-controlled study. Am J Psychiatr 165: Wu, R.R., Zhao, J.P., Jin, H., Shao, P., Fang, M.S., Guo, X.F., et al. (2008b). Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial. JAMA 299:

24 Questions?