November 22, 2006

Metabolic Syndrome (Diabetes) in Psychiatric Patients

From Symposium S10 Metabolic Health in Psychiatric Patients - 10 November 2006 Toronto.
Written By Marvin Ross.

An indispensable new tool for psychiatrists, according to Dr. Christian L Shriqui, is a tape measure. Psychiatrists should always take the waist measurement of their patients at the very first visit and at all subsequent visits thereafter. Dr. Claude Garceau reinforced this message in their joint presentation on the problems of the metabolic syndrome in psychiatric patients at the 56th Annual Conference of the Canadian Psychiatric Association meeting here.

Dr. Shriqui is associate professor of psychiatry at the University of Laval in Quebec City, Quebec, Canada and Dr. Garceau is an internist in the Institut Universitaire de Cardiologie et Pneumologie at Hopital Laval also in Quebec City.

The waist measure is a good simple indicator for the development of metabolic syndrome and diabetes as abdominal fat, Dr. Garceau said, is not passive. It produces TNFα - an inflammatory cytokine - that destroys cells in the pancreas and increases the risk for diabetes. This simple measure can be used to forewarn of potential problems.

Metabolic syndrome, they emphasized, is associated with all psychiatric medications and not just the atypical antipsychotics. Valproic acid, for example, has been shown to cause an increase in weight of between 8 to 59%, lithium 13 to 65% and paroxetine a mean weight gain of 14 kg in 5 months.

At the time of admission or start of treatment, patients should have their height, weight and waist circumference measured and their Body Mass Index (body weight in kilograms/height in meters squared; abbreviated BMI)calculated. Blood work should include a lipid profile, fasting blood glucose, TSH, prolactin and hemoglobin levels. Their blood pressure should be recorded and a complete personal and family physical history should be taken in addition to the psychiatric evaluation and history. Blood glucose abnormalities are more frequent in families of people with psychiatric disorders than in those without such disorders.

Metabolic syndrome is defined as having three or more of the risk factors of a waist circumference of > 40 inches for men and > 35 inches for women; triglycerides ≥ 1.7; HDL < 1 for men and < 1.3 for women; blood pressure ≥ 130/≥ 85; and a fasting glucose of ≥ 5.6.

Monitoring of these laboratory measures is essential and should be checked one month after the initiation of treatment and then at 3 and 6 months and annually thereafter, while the waist circumference should always be checked. It is much easier to prevent weight gain and metabolic syndrome before it occurs than after. Dr. Shriqui suggests referring patients for dietary counseling as he said that it takes nine hours of aerobic activity to burn off one pound of fat.

He added that many psychiatrists are reluctant to raise the problem of possible weight gain initially with patients for fear of increasing non-compliance and possible litigation. However, he believes that by pointing out the potential problems and offering solutions to avoid them you empower patients and achieve greater compliance.

Symposium S10 Metabolic Health in Psychiatric Patients - Toronto, Marvin Ross 10 November 2006

Additional Reading:
20% of people with Schizophrenia will get Diabetes?
Psychiatrists Not Meeting Schizophrenia Patient Needs
Management of Antipsychotic-Induced Weight Gain
Diet May Affect Outcome of Schizophrenia


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