Increased Health Risks Linked to First Psychotic Episode

New research has found that many patients experiencing their first psychotic episode have other health risks that could lead to premature death.

The study found that increased 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.

According to the researchers, patients entered treatment with significant health concerns, including being overweight, smoking, and metabolic issues, despite an average age of only 24 years.

The study, published in JAMA Psychiatry, is among the first to report results from the Recovery After an Initial Schizophrenia Episode (RAISE) project, which was developed by the National Institute of Mental Health to examine first episode psychosis before and after specialized treatment was offered in community settings.

Researchers studied nearly 400 individuals between the ages of 15 and 40 with first episode psychosis, who came for treatment at 34 community-based clinics across 21 states.

The researchers found that the frequency of obesity was similar to the general population. However, smoking and metabolic syndrome — a combination of conditions that includes obesity, high blood pressure, high blood sugar, and abnormal blood fats, such as cholesterol and triglycerides — were much more common.

The researchers also noted that dyslipidemia, an abnormal amount of blood fats such as cholesterol and triglycerides, and pre-hypertension in the relatively young group of patients were at least as high as rates typically found in people 15 to 20 years older.

Treatment with antipsychotic medication, even after a 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, the researchers reported.

The 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.

They note that patients need early interventions for psychiatric illness, lower-risk antipsychotic medications, routine monitoring and smoking cessation programs to improve health and reduce health care expenditures.

“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., of The Zucker Hillside Hospital, Hofstra North Shore-Long Island Jewish School of Medicine in New York.

“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,” he said.

“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.”

Source: National Institute of Mental Health