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April 25, 2005
Editorial - Diabetes and Schizophrenia
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It's nice to be able to write a positive editorial for a change and to point out where good things are happening in the treatment for those with schizophrenia. But first, the negative against which to counter balance this.
In the last issue of this newsletter, there was mention of a study out of the University of Georgia that found that Psychiatrists are only "doing a 'modest' job of monitoring for weight gain, diabetes and other metabolic problems that may result from use of the newer antipsychotics for schizophrenia."
The press release concluded by stating that, "much like the current study, a 2004 phone survey of 300 psychiatrists commissioned by a pharmaceutical company showed while most were aware of metabolic consequences many had not incorporated recommendations for dealing with them into their practice."
The dangers of obesity and the consequent heart problems and type II diabetes are problems for those on atypical antipsychotics but psychiatrists are not doing enough to counter them. Well, some are.
The Hamilton Program for Schizophrenia, a community based support program for people with schizophrenia in Hamilton, Ontario, Canada recently released their preliminary evaluation of a new program called H.E.A.L.T.H which stands for Healthy Eating and Activity: Lessons to Take to Heart.
They point out that obesity is 2-3 times more frequent amongst those with serious mental illness than the general population and that life style factors as well as the side effects of medications may help contribute to this phenomenon. They also make the point that there is no weight loss intervention designed specifically for this population group.
The goal of the H.E.A.L.T.H. program was to evaluate the effects on weight of a program that emphasized good nutrition, increased physical activity and behavioral strategies to reinforce lifestyle changes. The program recruited nine participants who were willing to take part in two, 12 week sessions. In the first session, participants attended for twice weekly 2 hour sessions.
The first session of the week focused on instruction about nutrition while the second session focused on physical activity. After the instruction, participants went on a brisk walk starting at 10 minutes and slowly increasing to 40 minutes. The second phase which is about to begin, will focus on the practical with cooking and more information on physical activity.
The results from the first session are impressive. The average age of the participants was 39.7 years and their average weight was 231.7 pounds (BMI of 35.6). Their average waist circumference was 46.4 inches. By the end of the first 12 weeks, participants had lost an average of 8.9 pounds. Just as important, they reported an improved sense of general health, an improved sense of vitality, and an improved self reported feeling of mental health.
The authors of the study (Angela Thomas, Deana Worne, and Joel Goldberg) point out that while the findings are only preliminary, there "appears to be promise for the efficacy of a psycho-educational health curriculum combined with exercise and weight monitoring for adults with schizophrenia living in the community". Even though physiological data was not available when they presented these results, they did point out that, in one case, blood glucose levels improved from borderline diabetic to normal.
This study demonstrates that treatment for those with schizophrenia should not stop simply when the prescription pad has been filled out. More programming like the one described here are needed in order to further help these people on the road to recovery.
But, there is also another concern in my opinion. Side effects of drugs are starting to get a great deal more attention particularly given the realization that hormone replacement therapy for older women might lead to heart attacks and the problems with the newer anti-arthritis drugs Vioxx and Bextra which have been pulled from the market.
I am now starting to see newspaper articles about the dangers of the atypical antipsychotics and the increased risk for heart problems and diabetes. I'm beginning to wonder if we might soon see a call to have these drugs withdrawn from the market. While there is an increased risk (some of which can be ameliorated by programs like the one in Hamilton), not all of the risk can be.
What many people do not understand is that there is a risk benefit ratio that must be taken into account when any drug is prescribed. What is the benefit of taking the drug against the possible risk. The risk of taking the atypical antipsychotics is an increased chance of developing type II diabetes and heart problems down the road. Some of that risk is from the action of the drug itself and some of it from the lifestyle of those taking it and the action of the disease itself.
People with schizophrenia are often poor and poor people often cannot afford to eat as well as they should. One of the symptoms of schizophrenia is poor motivation which may also doom the individual to a lifestyle deficient in good practices.
It is important to encourage good eating and exercise habits amongst people with serious mental illnesses and to not "throw the baby out with the bath water". Keeping psychotic symptoms under control and helping an individual to get the most out of life that they can is worth the risk of having them develop diabetes and heart problems.
Posted by szadmin at April 25, 2005 11:51 PM
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