Anti-psychotic drugs for treating serious mental illnesses, such as bipolar disorder or schizophrenia, are effective and often life-saving but come with unwelcome side effects. They dramatically increase weight as well as the incidence of metabolic disorders such as raised blood fats and Type 2 diabetes, say Sydney-based specialists. In fact, there are measurable effects within 3 to 6 months of starting treatment.
The rapid decline in physical health is so clinically significant1, and of such concern, that the specialists put together a physical health protection algorithm last year, which they say should run in tandem with mental health treatment. It includes regular and specified measurement of tangibles – weight, waistline and blood chemistry – as well as counselling about lifestyle and diet.
The new ‘treatment algorithm’ was devised by Associate Professor Katherine Samaras, Clinical Researcher at the Garvan Institute of Medical Research and endocrinologist at St Vincent’s Hospital, along with psychiatrist Dr Jackie Curtis and her colleagues from the Bondi Early Psychosis Program, Prince of Wales Hospital.
The treatment algorithm was adopted by NSW Health in June 2011, and is also being considered in the UK by the Royal College of Psychiatrists and the Royal College of General Practitioners. Under the aegis of the University of NSW, these clinical researchers have established an International working party on Physical Health in Youth with Psychosis (iphYs), launched in Sydney last month.
The collaborative research has resulted in a publication this week in the journal Early Intervention in Psychiatry. The current paper outlines the problem, and describes the Early Psychosis Program being run in Bondi as a model of care for young people with psychosis.
The Bondi program, which targets 15 to 25 year olds who are experiencing their first episode of psychosis, is co-ordinated by multi-disciplinary staff including clinical nurse specialists, occupational therapists, a clinical psychologist and a family therapist. It offers metabolic screening and monitoring as well as diet and lifestyle advice.
“As an endocrinologist, I regularly see the effects of metabolic syndrome and poorly controlled diabetes. These include kidney failure and amputation, tragedies we desperately wish to avoid,” said Associate Professor Katherine Samaras.
“There are thousands of people with psychosis, who are at risk of, or already have, serious metabolic diseases. People with psychosis have a life-expectancy 20 years less than the average Australian. They mostly die from cardiovascular causes, often with diabetes as a major factor. It became clear to me that a handful of endocrinologists would be unable to treat all the diabetes in this population. What is worse, much of this diabetes could be prevented by early intervention to prevent the weight gain that occurs on medications.”
“Imagine if we could protect the health of young people who have psychosis, to prevent them developing the physical health outcomes we frequently treat now. With the psychiatrists and other health professionals I’ve been working with, we put together a simple ‘how to‘ which we believe will immeasurably improve the physical health, and therefore the lives, of people with psychosis later on.”
“One thing we can do is intervene early and teach young people healthy habits in daily living. Another is ensure that we have systems in place to monitor them regularly and act immediately if signs of physical illness start to develop.”
“In practical terms, we need to develop an army of health care workers – doctors, nurses, occupational therapists, dieticians, exercise physiologists and so on – who can get involved. Most of the people I’ve met who work in this area see the same need to intervene to protect young people’s physical health and have just needed to be shown what to do and how to do it.”
“The peak onset time for psychosis is early adolescence. I believe that with very little effort early, we can get huge physical health benefits now and in the future.”
1. While there are few figures available in Australia that describe the extent of decline in physical health, American statistics suggest that ‘metabolic syndrome’ is two to three times more prevalent in young people being treated for mental illness than it is in the general population of the same age – around 4.5% of youths aged 12-17 meet the diagnostic criteria.
ABOUT THE BONDI CENTRE, EASTERN SUBURBS MENTAL HEALTH PROGRAM SOUTH EASTERN SYDNEY LOCAL HEALTH DISTRICT
The Bondi Centre, Early Psychosis Program, is part of the Eastern Suburbs Mental Health Program, South Eastern Sydney Local Health District, which operates from a large house in Sydney’s Bondi Junction and treats young people, aged15 to 25, who have experienced their first episode of psychosis. Comprised of a multidisciplinary team of psychiatric nurses, psychologist, psychiatrist, family therapist, dietician and occupational therapist, the Program performs a full mental health assessment on each client and manages the psychiatric, lifestyle and vocational recovery of its clients. The Program also conducts a two-year comprehensive multi-disciplinary recovery program- the RaDiCaL Group Program (Recovery and Discovery in Community and Lifestyle) to improve general physical health and promote a healthy lifestyle. Clients of the Program are also assisted by exercise physiologists and dieticians through the development of a healthy lifestyle plan and individualised exercises through the "Keeping the Body In Mind” program and use of the onsite gym at the Bondi Centre.