Metabolic Syndrome

For those who don’t know, metabolic syndrome is the name for the shitstorm of physical ailments that come from long-term use of antipsychotics. Well, that’s not exactly right. Let me quote a real authority, the American Heart Assn.:

The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

* Abdominal obesity (excessive fat tissue in and around the abdomen)
* Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
* Elevated blood pressure
* Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
* Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
* Proinflammatory state (e.g., elevated C-reactive protein in the blood)

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

So yes, it’s not just from psychotropics, but people with severe mental illnesses who take atypicals for more than 10 years are in an extremely high risk group. I’ve seen it too many times to count, and that doesn’t even begin to take into account what happens to a person psychologically when they’re not only overweight, but unable to be active in order to lose that weight.

Today Joe sent me this:

Metabolic monitoring in patients prescribed antipsychotics abysmal

Abysmal. That’s a serious word. From the piece:

Among insured patients newly prescribed second-generation antipsychotics, monitoring of blood glucose and lipid levels falls far short of 2004 American Diabetes Association (ADA) guidelines, researchers report [1].

The guidelines are based on substantial evidence that these drugs can increase risk for cardiovascular disease by affecting lipid and glucose metabolism and body weight.

However, this study showed that by 2006, just over 10% of patients newly prescribed second-generation antipsychotics received lipid monitoring and just over 20% received glucose monitoring.

“These numbers are unacceptably low, given that the ideal level of monitoring should be 100%,” lead author Dr Dan W Haupt (Washington University School of Medicine, St Louis, MO) said.

Joe suggests the following announcement:

Dear Psychiatrist,

You may not be aware that claims that SGAs are safer and more effective then FGAs turned out to be horse hooey. If not, you may have noticed that some of your patients just don’t come around anymore and when you attempt to call them threatening injectables to guarantee medication compliance, you find their phones are no longer in service. Well some of these folks are never coming back …. if you get what I mean. It may have something to do with Metabolic Syndrome.

First, it wasn’t your fault. Heck, you were just relying on what a pharma rep told you over the lunch brought from Panera. (Isn’t their Tomato & Mozzarella on Ciabatta Panini just great?)

Second, its been years since you practiced real blood and guts hands-on medicine and you’ve forgotten pretty much everything you learned in medical school. Third and most importantly, you value your home and you don’t want to loose it if some mental health patient a/k/a consumer, client, self-advocate, constituent, recipient – or his or her bereaved family has the audacity to sue you big time for malpractice.

So here is the skinny on Metabolic Syndrome:

Tools required to monitor for Metabolic Syndrome:
1. Blood collection set and syringe.
2. Tape measure.
3. Blood pressure cuff and stethoscope or an electronic device which does BP’s.

Skills required:
1. Ability to draw blood and and use a phone to call a lab for pick-up.
2. Ability to place a tape measure around patient’s waist and read circumference.
3. Ability to use blood pressure cuff and stethoscope or operate electronic BP device.

Alternative Procedure:
1. Grasp the same prescription pad and pen used to prescribe SGAs. (C’mon, you own a least 100 pharmaceutical labeled pens.)
2. Take pen and order the following – blood work, BP, waist circumference.
3. Direct patient to a local clinic.

Psychiatrists should be aware that their reliance on the alternative procedure is likely to cause some chuckles at the clinic, “And psychiatrists call themselves doctors,” but if our patients can stand a lot of humiliation we can certainly stand a little for the sake of our homes.

liz | 6:19 PM | BIG PHARMA, meds