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BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment
BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment
Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users’ negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance (‘pre-diabetes’), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.

These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.
0269-8811
1-32
Cooper, S.J.
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Reynolds, G.P.
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Barnes, T.R.E.
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England, E.
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Haddad, P.M.
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Heald, A.
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Holt, R.I.G.
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Lingford-Hughes, A.
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Osborn, D.
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McGowan, O.
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Patel, M.X.
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Paton, C.
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Reid, P.
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Shiers, D.
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Smith, J.
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Cooper, S.J.
bc982546-7a7d-4676-8804-a0b86774a109
Reynolds, G.P.
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Barnes, T.R.E.
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England, E.
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Haddad, P.M.
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Heald, A.
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Holt, R.I.G.
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Lingford-Hughes, A.
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Osborn, D.
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McGowan, O.
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Patel, M.X.
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Paton, C.
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Reid, P.
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Shiers, D.
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Smith, J.
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Cooper, S.J., Reynolds, G.P., Barnes, T.R.E., England, E., Haddad, P.M., Heald, A., Holt, R.I.G., Lingford-Hughes, A., Osborn, D., McGowan, O., Patel, M.X., Paton, C., Reid, P., Shiers, D. and Smith, J. (2016) BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. Journal of Psychopharmacology, 1-32. (doi:10.1177/0269881116645254). (PMID:27147592)

Record type: Article

Abstract

Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users’ negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance (‘pre-diabetes’), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.

These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.

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Accepted/In Press date: 30 March 2016
e-pub ahead of print date: 4 May 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 394640
URI: http://eprints.soton.ac.uk/id/eprint/394640
ISSN: 0269-8811
PURE UUID: 02b9382d-0c82-4e29-ad46-3fdc88552ac2
ORCID for R.I.G. Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 23 May 2016 09:01
Last modified: 18 Feb 2021 16:56

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Contributors

Author: S.J. Cooper
Author: G.P. Reynolds
Author: T.R.E. Barnes
Author: E. England
Author: P.M. Haddad
Author: A. Heald
Author: R.I.G. Holt ORCID iD
Author: A. Lingford-Hughes
Author: D. Osborn
Author: O. McGowan
Author: M.X. Patel
Author: C. Paton
Author: P. Reid
Author: D. Shiers
Author: J. Smith

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