Increased health risks linked to first-episode psychosis
Many patients with psychosis develop health risks associated with premature death early in the course of their mental illness, researchers have found.
Patients with schizophrenia are already known to have higher rates of premature death than the general population. The study found that elevated risks of heart disease and metabolic issues such as high blood sugar in people with first episode psychosis are due to an interaction of mental illness, unhealthy lifestyle behaviors and antipsychotic medications that may accelerate these risks.
Patients entered treatment with significant health concerns – including excess weight, smoking, and metabolic issues – despite an average age of only 24 years. The study identifies key opportunities for health care systems to improve the treatment of such patients with first episode psychosis. The research was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.
Christoph Correll, M.D., of The Zucker Hillside Hospital, Hofstra North Shore-Long Island Jewish School of Medicine, New York, and colleagues, report their findings on Oct. 8, 2014 in JAMA Psychiatry.
The study is among the first of several to report results from the Recovery After an Initial Schizophrenia Episode (RAISE) project, which was developed by NIMH to examine first episode psychosis before and after specialized treatment was offered in community settings.
The researchers studied nearly 400 individuals between the ages of 15 and 40 with first episode psychosis, who presented for treatment at 34 community-based clinics across 21 states.
The frequency of obesity was similar to the same age group in the general population. However, smoking and metabolic syndrome (a combination of conditions including obesity, high blood pressure, high blood sugar, and abnormal blood fats, such as cholesterol and triglycerides) were much more common. Frequencies of dyslipidemia (an abnormal amount of blood fats, such as cholesterol and triglycerides) and pre-hypertension in this relatively young group of study participants were at least as high as rates typically found in people 15-20 years older.
Notably, treatment with antipsychotic medication, even after brief exposure (participants' average exposure was 47 days), was associated with an increased risk of metabolic syndrome, which is a major risk for future cardiovascular illness.
Researchers concluded that people with first episode psychosis need a team-based health care approach that combines psychiatric and general medical care to address the full range of needs. Patients need early interventions for psychiatric illness, lower-risk antipsychotic medications, routine monitoring, and smoking cessation programs to improve health and reduce healthcare expenditures1.
"Our results strongly suggest that clinicians need to pay much more attention to promoting physical health in people with severe mental illness," said lead author Christoph Correll, M.D. "We need to routinely educate patients about healthy lifestyle behaviors, monitor physical health, choose lower risk treatments whenever possible, and manage issues as they arise. Without a combined physical and mental health care approach, we miss major opportunities to improve psychiatric as well as medical health in patients with schizophrenia and other severe conditions."
More information: Correll CU, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA, Marcy P, Addington J, Estroff SE, Robinson J, Penn D, Azrin S, Goldstein A, Severe J, Heinssen R, Kane JM. Cardiometabolic Risk in First Episode Schizophrenia-Spectrum Disorder Patients: Baseline Results from the RAISE-ETP Study, JAMA Psychiatry, Oct. 8, 2014. doi:10.1001/jamapsychiatry.2014.1314.