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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Obesity, cardiovascular disease and type 2 diabetes in people with a mental illness: a need for primary health care

Susanne H. Stanley A B and Jonathan D. E. Laugharne A
+ Author Affiliations
- Author Affiliations

A Community, Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Fremantle Hospital, W Block, L6, 1 Alma Street, Fremantle, WA 6160, Australia.

B Corresponding author. Email: susanne.stanley@uwa.edu.au

Australian Journal of Primary Health 18(3) 258-264 https://doi.org/10.1071/PY11045
Submitted: 5 April 2011  Accepted: 14 October 2011   Published: 29 November 2011

Abstract

People with a mental illness show a growing incidence of obesity, and higher rates of metabolic syndrome when compared with the general population. This paper reviews research on obesity, cardiovascular disease and type 2 diabetes, with the aim of directing clinical attention towards the improvement of patient physical health. A systematic search of cross-discipline databases and journals provided peer-reviewed research for analysis, and national statistics allowed for the investigation of differences in rates of occurrence between people experiencing a mental illness and the general population. Treatment effects via psychotropic medications and lifestyle factors such as poor diet and low levels of exercise suggest that ongoing monitoring is necessary to prevent major physical disorders in people experiencing a mental illness. To aid clinicians, a comprehensive set of clinical guidelines have been developed for the physical assessment and ongoing monitoring of mental health patients.

Additional keyword: physical health.


References

Allison DB, Newcomer JW, Dunn AL, Blumenthal JA, Fabricatore AN, Daumit GL, Cope MB, Riley WT, Vreeland B, Hibbeln JR, Alpert JE (2009) Obesity among those with mental disorders. American Journal of Preventive Medicine 36, 341–350.
Obesity among those with mental disorders.Crossref | GoogleScholarGoogle Scholar | 19285199PubMed |

Andersohn F, Schade R, Suissa S, Garbe E (2009) Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus. The American Journal of Psychiatry 166, 591–598.
Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus.Crossref | GoogleScholarGoogle Scholar | 19339356PubMed |

Australian Bureau of Statistics (2006) ‘Cardiovascular disease in Australia: A snapshot, 2004–05.’ Cat. no. 4821.0.55.001. (ABS: Canberra) Available at http://www.abs.gov.au/ausstats/ [Verified 29 May 2009]

Australian Bureau of Statistics (2008) ‘Australian social trends, December 2009.’ Cat. no. 4102.0. (ABS: Canberra) Available at http://www.abs.gov.au/ausstats/ [Verified 21 December 2009]

Australian Bureau of Statistics (2009) ‘National Health Survey: summary of results 2007–2008.’ Cat. no. 4364.0. (ABS: Canberra) Available at http://www.abs.gov.au/ausstats/ [Verified 21 December 2009]

Australian Institute of Health and Welfare, National Heart Foundation of Australia (2004) ‘The relationship between overweight, obesity and cardiovascular disease.’ AIHW cat. no. CVD 29. Cardiovascular disease series no. 23. (AIHW: Canberra)

Barnes TRE, Paton C, Hancock E, Cavanagh MR, Taylor D, Lelliott P (2008) Screening for the metabolic syndrome in community psychiatric patients prescribed antipsychotics: a quality improvement programme. Acta Psychiatrica Scandinavica 118, 26–33.
Screening for the metabolic syndrome in community psychiatric patients prescribed antipsychotics: a quality improvement programme.Crossref | GoogleScholarGoogle Scholar |

Basu A, Meltzer HY (2006) Differential trends in prevalence of diabetes and unrelated general medical illness for schizophrenia patients before and after the atypical antipsychotic era. Schizophrenia Research 86, 99–109.
Differential trends in prevalence of diabetes and unrelated general medical illness for schizophrenia patients before and after the atypical antipsychotic era.Crossref | GoogleScholarGoogle Scholar | 16753284PubMed |

Bender R, Zeeb H, Schwarz M, Jockel KH, Berger M (2006) Causes of death in obesity: Relevant increase in cardiovascular but not in all-cancer mortality. Journal of Clinical Epidemiology 59, 1064–1071.
Causes of death in obesity: Relevant increase in cardiovascular but not in all-cancer mortality.Crossref | GoogleScholarGoogle Scholar | 16980146PubMed |

Brown LC, Majumdar SR, Johnson JA (2008) Type of antidepressant therapy and risk of type 2 diabetes in people with depression. Diabetes Research and Clinical Practice 79, 61–67.
Type of antidepressant therapy and risk of type 2 diabetes in people with depression.Crossref | GoogleScholarGoogle Scholar | 17714823PubMed |

Citrome L, Jaffe A, Levine J, Allingham B, Robinson J (2004) Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients. Psychiatric Services 55, 1006–1013.
Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients.Crossref | GoogleScholarGoogle Scholar | 15345760PubMed |

Cohen D, Groebbe DE, Stolk RP, Gispen-de Wied CC (2006) Hyperglycemia and diabetes in patients with schizophrenia or schizoaffective disorders. Diabetes Care 29, 786–791.
Hyperglycemia and diabetes in patients with schizophrenia or schizoaffective disorders.Crossref | GoogleScholarGoogle Scholar | 16567816PubMed |

Commonwealth of Australia (2010) ‘National mental health strategy: national standards for mental health services.’ Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-servst10

Daumit GL, Goff DC, Meyer JM, Davis VG, Nasrallah HA, McEvoy JP, Rosenheck R, Davis SM, Hsiao JK, Stroup TS, Lieberman JA (2008) Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study. Schizophrenia Research 105, 175–187.
Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study.Crossref | GoogleScholarGoogle Scholar | 18775645PubMed |

De Hert M, Schreurs V, Vancampfort D, Van Winkel R (2009) Metabolic syndrome in people with schizophrenia: a review. World Psychiatry; Official Journal of the World Psychiatric Association (WPA) 8, 15–22.

Dekker JM, Girman C, Rhodes T, Nijpels G, Stehouwer CDA, Bouter LM, Heine RJ (2005) Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn study. Circulation 112, 666–673.
Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn study.Crossref | GoogleScholarGoogle Scholar | 16061755PubMed |

Diabetes Australia (2009) ‘Type 2 diabetes.’ Available at http://diabetesaustralia.com.au/Understanding-Diabetes/What-is-Diabetes/Type-2-Diabetes/ [Verified 30 July 2009]

Elmslie JL, Mann JI, Silverstone JT, Williams SM, Romans SE (2001) Determinants of overweight and obesity in patients with bipolar disorder. The Journal of Clinical Psychiatry 62, 486–491.
Determinants of overweight and obesity in patients with bipolar disorder.Crossref | GoogleScholarGoogle Scholar | 11465534PubMed |

Guy W (1976) ‘ECDEU assessment manual for psychopharmacology–revised.’ DHEW publ. no. ADM 76-338. (US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs: Rockville, MD)

Hardy S, White J, Deane K, Gray R (2011) Educating healthcare professionals to act on the physical health needs of people with serious mental illness: a systematic search for evidence. Journal of Psychiatric and Mental Health Nursing 18, 721–727.
Educating healthcare professionals to act on the physical health needs of people with serious mental illness: a systematic search for evidence.Crossref | GoogleScholarGoogle Scholar | 21896115PubMed |

Harris EC, Barraclough B (1998) Excess mortality of mental disorder. The British Journal of Psychiatry 173, 11–53.
Excess mortality of mental disorder.Crossref | GoogleScholarGoogle Scholar | 9850203PubMed |

Haupt DW, Fahnestock PA, Flavin KA, Schweiger JA, Stevens A, Hessler MJ, Maeda J, Yingling M, Newcomer JW (2007) Adiposity and insulin sensitivity derived from intravenous glucose tolerance tests in antipsychotic-treated patients. Neuropsychopharmacology 32, 2561–2569.
Adiposity and insulin sensitivity derived from intravenous glucose tolerance tests in antipsychotic-treated patients.Crossref | GoogleScholarGoogle Scholar | 17375138PubMed |

Hilton T (2007) Pharmacological issues in the management of people with mental illness and problems with alcohol and illicit drug misuse. Criminal Behaviour and Mental Health 17, 215–224.
Pharmacological issues in the management of people with mental illness and problems with alcohol and illicit drug misuse.Crossref | GoogleScholarGoogle Scholar | 17902116PubMed |

John AP, Koloth R, Dragovic M, Lim SCB (2009) Prevalence of metabolic syndrome among Australians with severe mental illness. The Medical Journal of Australia 190, 176–179.

Jones DR, Macia C, Barreira PJ, Fisher WH, Hargreaves WA, Harding CM (2004) Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services 55, 1250–1257.
Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness.Crossref | GoogleScholarGoogle Scholar | 15534013PubMed |

Khan AY, Macaluso M, Mchale RJ, Dahmen MM, Girrens K, Ali F (2010) The adjunctive use of metformin to treat or prevent atypical antipsychotic-induced weight gain: a review. Journal of Psychiatric Practice 16, 289–296.
The adjunctive use of metformin to treat or prevent atypical antipsychotic-induced weight gain: a review.Crossref | GoogleScholarGoogle Scholar | 20859106PubMed |

Kim S, Popkin BM (2006) Commentary: Understanding the epidemiology of overweight and obesity – a real global public health concern. International Journal of Epidemiology 35, 60–67.
Commentary: Understanding the epidemiology of overweight and obesity – a real global public health concern.Crossref | GoogleScholarGoogle Scholar | 16339598PubMed |

Lawrence D, Holman CDJ, Jablensky AV (2001) ‘Duty to care: preventable physical illness in people with mental illness.’ (The University of Western Australia: Perth)

Magliano DJ, Barr ELM, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S, Jolley D, Owen N, Phillips P, Tapp RJ, Welborn TA, Shaw JE (2008) Glucose indices, health behaviors, and incidence of diabetes in Australia: The Australian diabetes, obesity and lifestyle study. Diabetes Care 31, 267–272.
Glucose indices, health behaviors, and incidence of diabetes in Australia: The Australian diabetes, obesity and lifestyle study.Crossref | GoogleScholarGoogle Scholar | 17989310PubMed |

Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, Kane JM, Lieberman JA, Schooler NR, Covell N, Stroup S, Weissman EM, Wirshing DA, Hall CS, Pogach L, Pi-Sunyer X, Bigger JT, Friedman A, Kleinberg D, Yevich SJ, Davis B, Shon S (2004) Physical health monitoring of patients with schizophrenia. The American Journal of Psychiatry 161, 1334–1349.
Physical health monitoring of patients with schizophrenia.Crossref | GoogleScholarGoogle Scholar | 15285957PubMed |

McIntyre RS, Rasgon NL, Kemp DE, Nguyen HT, Law CW, Taylor VH, Woldeyohannes HO, Alsuwaidan MT, Soczynska JK, Kim B, Lourenco MT, Kahn LS, Goldstein BI (2009) Metabolic syndrome and major depressive disorder: co-occurrence and pathophysiologic overlap. Current Diabetes Reports 9, 51–59.
Metabolic syndrome and major depressive disorder: co-occurrence and pathophysiologic overlap.Crossref | GoogleScholarGoogle Scholar | 19192425PubMed |

Meyer JM, Stahl SM (2009) The metabolic syndrome and schizophrenia. Acta Psychiatrica Scandinavica 119, 4–14.
The metabolic syndrome and schizophrenia.Crossref | GoogleScholarGoogle Scholar | 19133915PubMed |

Morris CD, Giese AA, Turnbull JJ, Dickinson M, Johnson-Nagel N (2006) Predictors of tobacco use among persons with mental illness in a statewide population. Psychiatric Services 57, 1035–1038.
Predictors of tobacco use among persons with mental illness in a statewide population.Crossref | GoogleScholarGoogle Scholar | 16816291PubMed |

National Health and Medical Research Council (2009) ‘NHMRC levels of evidence and grades for recommendations for developers of guidelines.’ (Australian Government, NHMRC: Canberra)

Newcomer JW (2007) Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. The Journal of Clinical Psychiatry 68, 20–27.

Oldham J (2010) Countering side effects. Journal of Psychiatric Practice 16, 285
Countering side effects.Crossref | GoogleScholarGoogle Scholar | 20859105PubMed |

Osborn DPJ, Nazareth I, King MB (2007) Physical activity, dietary habits and coronary heart disease risk factor knowledge amongst people with a severe mental illness. Social Psychiatry and Psychiatric Epidemiology 42, 787–793.
Physical activity, dietary habits and coronary heart disease risk factor knowledge amongst people with a severe mental illness.Crossref | GoogleScholarGoogle Scholar |

Porter J, Evans S (2008) Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future. Nutrition & Dietetics 65, 6–9.
Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future.Crossref | GoogleScholarGoogle Scholar |

Ray WA, Meredith S, Thapa PB, Meador KG, Hall K, Murray KT (2001) Antipsychotics and the risk of sudden cardiac death. Archives of General Psychiatry 58, 1161–1167.
Antipsychotics and the risk of sudden cardiac death.Crossref | GoogleScholarGoogle Scholar | 11735845PubMed |

Rivenes AC, Harvey SB, Mykletun A (2009) The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT Study. Journal of Psychosomatic Research 66, 269–275.
The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT Study.Crossref | GoogleScholarGoogle Scholar | 19302883PubMed |

Sacher J, Mossaheb N, Spindelegger C, Klein N, Geiss-Granadia T, Sauermann R, Lackner E, Joukhadar C, Muller M, Kasper S (2008) Effects of olanzapine and ziprasidone on glucose tolerance in healthy volunteers. Neuropsychopharmacology 33, 1633–1641.
Effects of olanzapine and ziprasidone on glucose tolerance in healthy volunteers.Crossref | GoogleScholarGoogle Scholar | 17712347PubMed |

Saddichha S, Manjunatha N, Ameen S, Akhtar S (2008) Diabetes and schizophrenia – effect of disease or drug? Results from a randomized, double-blind, controlled prospective study in first-episode schizophrenia. Acta Psychiatrica Scandinavica 117, 342–347.
Diabetes and schizophrenia – effect of disease or drug? Results from a randomized, double-blind, controlled prospective study in first-episode schizophrenia.Crossref | GoogleScholarGoogle Scholar | 18307585PubMed |

Schwartz TL, Nihalani N, Jindal S, Virk S, Jones N (2004) Psychiatric medication-induced obesity: A review. Obesity Reviews 5, 115–121.
Psychiatric medication-induced obesity: A review.Crossref | GoogleScholarGoogle Scholar | 15086865PubMed |

Scott KM, McGee MA, Wells JE, Oakley Browne MA (2008) Obesity and mental disorders in the adult general population. Journal of Psychosomatic Research 64, 97–105.
Obesity and mental disorders in the adult general population.Crossref | GoogleScholarGoogle Scholar | 18158005PubMed |

Slørdal L, Spigset O (2006) Heart failure induced by non-cardiac drugs. Drug Safety 29, 567–586.
Heart failure induced by non-cardiac drugs.Crossref | GoogleScholarGoogle Scholar | 16808550PubMed |

Sowell M, Mukhopadhyay N, Cavazzoni P, Carlson C, Mudaliar S, Chinnapongse S, Ray A, Davis T, Breier A, Henry RR, Dananberg J (2003) Evaluation of insulin sensitivity in healthy volunteers treated with olanzapine, risperidone, or placebo: a prospective, randomized study using the two-step hyperinsulinemic, euglycemic clamp. The Journal of Clinical Endocrinology and Metabolism 88, 5875–5880.
Evaluation of insulin sensitivity in healthy volunteers treated with olanzapine, risperidone, or placebo: a prospective, randomized study using the two-step hyperinsulinemic, euglycemic clamp.Crossref | GoogleScholarGoogle Scholar | 14671184PubMed |

Stanley S, Laugharne J (2010) ‘Clinical guidelines for the physical care of mental health consumers.’ (Community, Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, the University of Western Australia: Perth) Available at http://www.psychiatry.uwa.edu.au/research/community-culture/physical-care-clinical-guidelines [Verified 11 March 2011]

Stanley S, Laugharne J (2011) Clinical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians. Australian and New Zealand Journal of Psychiatry 45, 824–829.

Stern MP, Williams K, Gonzalez-Villalpando C, Hunt KJ, Haffner SM (2004) Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 27, 2676–2681.
Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease?Crossref | GoogleScholarGoogle Scholar | 15505004PubMed |

Strine TW, Mokdad AH, Dube SR, Balluz LS, Gonzalez O, Berry JT, Manderscheid R, Kroenke K (2008) The association of depression and anxiety with obesity and unhealthy behaviours among community-dwelling US adults. General Hospital Psychiatry 30, 127–137.
The association of depression and anxiety with obesity and unhealthy behaviours among community-dwelling US adults.Crossref | GoogleScholarGoogle Scholar | 18291294PubMed |

Taylor D, Young C, Esop R, Paton C, Walwyn R (2004) Testing for diabetes in hospitalized patients prescribed antipsychotic drugs. The British Journal of Psychiatry 185, 152–156.
Testing for diabetes in hospitalized patients prescribed antipsychotic drugs.Crossref | GoogleScholarGoogle Scholar | 15286067PubMed |

Tschoner A, Engl J, Laimer M, Kaser S, Rettenbacher M, Fleischhacker WW, Patsch JR, Ebenbichler CF (2007) Metabolic side effects of antipsychotic medication. International Journal of Clinical Practice 61, 1356–1370.
Metabolic side effects of antipsychotic medication.Crossref | GoogleScholarGoogle Scholar | 17627711PubMed |

Vidarsdottir S, de Leeuw van Weenen JE, Frolich M, Roelfsema F, Romijn JA, Pijl H (2010) Effects of olanzapine and haloperidol on the metabolic status of healthy men. The Journal of Clinical Endocrinology and Metabolism 95, 118–125.
Effects of olanzapine and haloperidol on the metabolic status of healthy men.Crossref | GoogleScholarGoogle Scholar | 19906788PubMed |

Waterreus AJ, Laugharne JDE (2009) Screening for the metabolic syndrome in patients receiving antipsychotic treatment: A proposed algorithm. The Medical Journal of Australia 190, 185–189.

Whang W, Kubzansky LD, Kawachi I, Rexrode KM, Kroenke CH, Glynn RJ, Garan H, Albert CM (2009) Depression and risk of sudden cardiac death and coronary heart disease in women: results from the nurses’ health study. Journal of the American College of Cardiology 53, 950–958.
Depression and risk of sudden cardiac death and coronary heart disease in women: results from the nurses’ health study.Crossref | GoogleScholarGoogle Scholar | 19281925PubMed |

White J, Gray R, Jones M (2009) Development of the serious mental illness health improvement profile. Journal of Psychiatric and Mental Health Nursing 16, 493–498.
Development of the serious mental illness health improvement profile.Crossref | GoogleScholarGoogle Scholar | 19538607PubMed |

Whittemore R, Knafl K (2005) The integrative review: updated methodology. Journal of Advanced Nursing 52, 546–553.
The integrative review: updated methodology.Crossref | GoogleScholarGoogle Scholar | 16268861PubMed |

World Health Organization (2000) ‘Obesity: preventing and managing the global epidemic. Report of a WHO consultation.’ WHO technical report series 894. (World Health Organization: Geneva)

Wu M-K, Huang C-Y, Liou YJ, Wang C-K, Lee S-D (2008) Glucose–insulin homeostasis, lipid profiles and GH–IGF–IGFBP axis in clozapine-treated schizophrenic obesity versus non-psychiatric obesity. International Journal of Obesity 32, 436–442.
Glucose–insulin homeostasis, lipid profiles and GH–IGF–IGFBP axis in clozapine-treated schizophrenic obesity versus non-psychiatric obesity.Crossref | GoogleScholarGoogle Scholar | 17955031PubMed |

Yamada J, Sugimoto Y, Inoue K (1999) Selective serotonin reuptake inhibitors fluoxetine and fluvoxamine induce hyperglycemia by different mechanisms. European Journal of Pharmacology 382, 211–215.
Selective serotonin reuptake inhibitors fluoxetine and fluvoxamine induce hyperglycemia by different mechanisms.Crossref | GoogleScholarGoogle Scholar | 10556672PubMed |

Zimmermann U, Kraus T, Himmerich H, Schuld A, Pollmacher T (2003) Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. Journal of Psychiatric Research 37, 193–220.
Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients.Crossref | GoogleScholarGoogle Scholar | 12650740PubMed |

Zimmet PZ, Alberti KG, Shaw JE (2005) Mainstreaming the metabolic syndrome: a definitive definition. The Medical Journal of Australia 183, 175–176.