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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The management of risk is a fundamental component of the work of mental health nurses and is most commonly associated with aggressive, violent and suicidal behaviours exhibited by those suffering from mental illness. However, people with severe mental illness are increasingly at risk of experiencing a number of related and complex health problems that include obesity, diabetes and cardiovascular disease. This group also has much higher rates of morbidity and mortality than that of the general population resulting in high social, economic and individual costs. Some of the barriers to receiving prompt and appropriate physical health care include lack of recognition by health professionals and the difficulties faced by consumers of mental health services in negotiating the health care system. Establishment of comprehensive (addressing both physical and mental health issues) programmes of care can address this need and offer additional opportunities for closer and more collaborative nurse-patient relationships. This paper explores risk factors for medical co-morbidity for people living with schizophrenia and suggests strategies that can facilitate better health outcomes.
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PMID:Medical co-morbidity risk factors and barriers to care for people with schizophrenia. 1686 29

Metabolic abnormalities such as obesity, diabetes and dyslipidaemia increase the risk of cardiovascular disease, as well as a number of other adverse long-term health consequences. There is increasing evidence from case studies, retrospective analyses and clinical trials to suggest that second-generation antipsychotics can increase the risk of metabolic abnormalities in patients with schizophrenia, with indications that the level of risk may vary among antipsychotic medications. Comparison of weight gain data for the second-generation antipsychotics provides strong evidence to indicate differences in the weight gain liability, with clozapine and olanzapine being associated with the greatest weight gain over 1 year. Data suggest that these treatment-induced changes in weight are primarily responsible for treatment-related changes in glucose metabolism; however, there is also evidence to suggest that some impairments in glucose metabolism may be independent of adiposity. Studies investigating the effects of atypical antipsychotics on glucose metabolism have used a number of techniques of varying sensitivity and quality in an attempt to assign causality. Recent studies using gold standard methodologies, for both insulin sensitivity and adiposity, have shown that psychiatric patients receiving antipsychotics are at least as sensitive to the adverse effects of adiposity on glucose and lipid metabolism as non-psychiatric controls. This demonstrates the importance of weight gain prevention in psychiatry to help reduce long-term risk. There is also growing evidence to suggest that the differential effects of second-generation antipsychotics on metabolic parameters also result in differences in the risk of metabolic syndrome, with olanzapine having a significantly higher risk than either aripiprazole or ziprasidone. This differential risk highlights the need for adequate monitoring in patients receiving treatment with second-generation antipsychotics and careful selection of treatment in high-risk patients.
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PMID:Differential metabolic effects of antipsychotic treatments. 1687 8

Patients with schizophrenia and bipolar disorder are vulnerable to developing key modifiable risk factors for cardiovascular disease, such as obesity, smoking, hypertension, dyslipidemia, and type 2 diabetes mellitus. In addition, mood stabilizers, anticonvulsants, and antipsychotic medications, which are commonly used to treat schizophrenia and bipolar disorder, have been linked to risk for adverse metabolic changes in patients. This article reviews the current literature on the prevalence of medical risk factors in the general population as well as in those patients with schizophrenia or bipolar disorder and discusses treatment strategies and lifestyle changes that patients can make in order to reduce their risks for certain diseases.
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PMID:Medical risk in patients with bipolar disorder and schizophrenia. 1696 86

Human ability to experience negative and positive emotions has an evolutionary perspective and the presence of feelings designed to influence behavior should thus be reflected in physiological and immune interactions. The complex interactions between the immune system and the central nervous system have been studied extensively in schizophrenia and depression. On the other hand, effects of positive human emotions, especially happiness, on physiological parameters and immunity have received very little attention. Emotions are intimately involved in the initiation or progression of cancer, HIV, cardiovascular disease, and autoimmune disorders. The specific physiological responses induced by pleasant stimuli were recently investigated with the immune and endocrine systems being monitored when pleasant stimuli such as odors and emotional pictures were presented to subjects. The results revealed that an increase in secretory immunoglobulin A and a decrease in salivary cortisol were induced by pleasant emotions. The mechanisms by which positive as opposed to negative states are instantiated in the brain and interact with the immune system are not yet understood. The present review investigates relations among physiological measures of affective style, psychological well-being, and immune function. There is data to support the hypothesis that individuals characterized by a more negative affective style poorly recruit their immune response and may be at risk for illness more so than those with a positive affective style. Future research is needed to expand our knowledge of the physiological and immune interactions of positive emotional states and their beneficial effects on health.
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PMID:The immune system and happiness. 1702 86

Homocysteine levels are affected by diet factors such as vitamin deficiencies, non-diet factors such as genetic disorders, and stress exposure. Hyperhomocysteinemia has been implicated in several disorders, including cardiovascular disease, depression, schizophrenia, Alzheimer's and Parkinson's disease. Since sex differences play a role both in stress responses and in susceptibility to various diseases, the objective of this study was to evaluate possible alterations in homocysteine metabolism including cysteine, folate, and vitamin B(6), and oxidative stress markers in female rats exposed to different types of acute stress. Female rats were randomly distributed into eight groups according to stress manipulation (restraint, swimming, cold and control) and estrous cycle (diestrus and estrus). In general no significant differences were seen between rats in estrus and diestrus. Restraint stress was the only type of stress that altered homocysteine concentrations (+33% relative to controls). An increase in levels of thiobarbituric acid reactive substances (TBARS) and a decrease in total glutathione (GSHt) concentration were also observed in animals subjected to restraint and swimming stress, suggesting the possibility of oxidative damage. Thus, both the homocysteine results and the oxidative stress data indicated that restraint stress was the most powerful stress manipulation in female rats, as previously observed in male rats. These findings indicate that hormonal and gonadal differences do not interfere with stress responses related to homocysteine metabolism and suggest that putative gender-related differences in homocysteine responses are probably not involved in the differential prevalence of some diseases in human males and females.
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PMID:Acute stressor-selective effects on homocysteine metabolism and oxidative stress parameters in female rats. 1705 2

Bupropion was initially developed and licensed for the treatment of major depressive disorder in the United States in 1989. It was licensed as a pharmacotherapy for smoking cessation in the United States in 1997 and in the United Kingdom in 2000, and for the prevention of seasonal major depressive episodes in patients with seasonal affective disorder in the United States in 2006. Its main mechanism of action is believed to be via dopamine and noradrenalin reuptake inhibition. In addition to proven clinical efficacy for the treatment of major depression, the prevention of depressive episodes in patients with seasonal affective disorder, and as an aid to smoking cessation treatment, bupropion has demonstrated efficacy for attenuation of symptoms of attention deficit hyperactivity disorder, and more recently it has shown anti-inflammatory action against proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha), which may be implicated in a number of inflammatory diseases such as Crohn's disease. The twice-daily sustained-release formulation has been extensively evaluated for smoking cessation and has shown continuous smoking abstinence rates at one year of the order of 20% across many clinical groups including healthy smokers, and smokers with cardiovascular disease, chronic obstructive airways disease, depression and schizophrenia. Bupropion is well tolerated with side effects including insomnia, headache, dry mouth, dizziness and nausea. Bupropion is a cytochrome p450 2D6 inhibitor and care must be taken when coprescribing with drugs cleared by this enzyme and when coprescribing with drugs that lower seizure threshold. Despite the clinical effectiveness and cost-effectiveness of bupropion as an aid to smoking cessation, its uptake for this indication remains low when compared with nicotine replacement therapy.
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PMID:Bupropion. 1713 26

Mortality rates in patients with schizophrenia are double compared with the general population, with cardiovascular disease causing 50% of the excess. Lowering low-density lipoprotein cholesterol is recognized as a primary target for the prevention of cardiovascular mortality. The effects of lipid-lowering treatment were evaluated in patients with schizophrenia. Forty-six patients with schizophrenia and with severe dyslipidaemia were identified. All were treated with antipsychotics. Patients were screened for cardiovascular risk factors and examined at baseline when statin therapy was initiated. The effects of lipid-lowering medication on lipid profile, glucose homeostasis and components of metabolic syndrome were evaluated at 3 months follow-up. After 3 months of statin therapy, a significant decrease in triglycerides, total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and, in associated ratios, low-density lipoprotein/high-density lipoprotein, cholesterol/high-density lipoprotein was observed. No significant changes occurred in high-density lipoprotein cholesterol, body mass index, waist circumference or glucose homeostasis. The only component of metabolic syndrome affected by statin therapy has been the serum triglyceride level. Statins proved effective in the management of dyslipidaemia in patients with schizophrenia treated with antipsychotics. More complex treatment may be required for associated metabolic disturbances.
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PMID:Pharmacological treatment of severe dyslipidaemia in patients with schizophrenia. 1715 59

Patients with schizophrenia and bipolar disorder are vulnerable to developing key modifiable risk factors for cardiovascular disease, such as obesity, smoking, hypertension, dyslipidemia, and type 2 diabetes mellitus. In addition, mood stabilizers, anticonvulsants, and antipsychotic medications, which are commonly used to treat schizophrenia and bipolar disorder, have been linked to risk for adverse metabolic changes in patients. This review reports the prevalence of medical risk factors in the general population as well as in those patients with schizophrenia or bipolar disorder and discusses treatment strategies and lifestyle changes that patients can make in order to reduce their risks for certain diseases.
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PMID:Medical risk in patients with bipolar disorder and schizophrenia. 1720 Oct 46

Patients with schizophrenia are at increased risk for cardiovascular disease as a consequence of lifestyle habits, impaired access to health care, and, increasingly, due to metabolic side effects ostensibly attributed to second-generation antipsychotics (SGAs). There is little evidence, however, on the extent and temporal patterns of SGA-associated metabolic side effects. We longitudinally examined the differential prevalence rates of obesity, diabetes mellitus, and diabetic ketoacidosis among inpatients with schizophrenia compared with control inpatients without schizophrenia. The data were derived from the National Inpatient Sample, the largest all-payer inpatient care database in the United States consisting of 5 to 8 million inpatient hospital stays per year sampled to approximate a 20% sample of community hospitals from 1988 to 2002. Overlaid on these observations was the market penetration data for SGAs. In 1988, the net difference from controls in obesity prevalence among inpatients with schizophrenia was +4.7%; by 2002, this difference had widened to +14.7%. Similarly, a significant increase in net prevalence of diabetes mellitus and diabetic ketoacidosis was observed from 1988 to 2002 among schizophrenic inpatients. In conclusion, after the introduction of SGAs, patients with schizophrenia in the United States have experienced a striking net increase in the prevalence of obesity and diabetes mellitus. This is likely to significantly add to an already elevated risk for cardiovascular disease in this population. Further investigations are urgently required so that health policy can be appropriately amended for preventive measures.
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PMID:Second-generation antipsychotic exposure and metabolic-related disorders in patients with schizophrenia: an observational pharmacoepidemiology study from 1988 to 2002. 1862 79

Compared with the general population, persons with schizophrenia have up to a 20% shorter lifespan, with cardiovascular disease as the leading cause of death. In addition, persons with schizophrenia have increased prevalence of the metabolic syndrome (obesity, insulin resistance, dyslipidemia, impaired glucose tolerance, and hypertension), increased prevalence of risk factors such as smoking, poverty, and poor nutrition, and reduced access to medical care. Results from the recent Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) provide further evidence of the metabolic risk associated with different atypical antipsychotics. Based on this study and a growing number of other randomized clinical trials, clozapine and olanzapine treatment can produce substantial mean changes in weight and an increased risk of associated metabolic disturbances. Risperidone and quetiapine treatment can produce intermediate changes in mean weight in comparison to treatment with other atypical antipsychotics, with discrepant results with respect to metabolic risk. Aripiprazole and ziprasidone treatment induced the lowest mean changes in weight gain and had no effect on risk for adverse metabolic changes, among currently available atypical agents. Considerable evidence indicates that mentally ill patients often do not receive adequate recognition of, monitoring of, or care for their medical illnesses. There is a critical need for psychiatrists and primary care professionals to increase awareness of and attention to the physical health problems of persons with mental illness, including appropriate management of metabolic adverse events associated with psychiatric medications.
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PMID:Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. 1728 24


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