RESUMEN
OBJECTIVE: To assess the incidence of cardiovascular diseases (CVD) and type-2-diabetes in patients with psychiatric disorders. METHODS: A population-based study was conducted using the Swedish national health registries. Patients were identified from the Electronic Medical Records (EMR) in 20 primary care centers and were categorized in four diagnosis cohorts according to their first psychiatric diagnosis: bipolar disorder, schizophrenia, major depressive disorder, or other mood disorder. A control cohort of patients with no psychiatric disorders followed in the same primary care centers was also identified. Incident CVD and type-2-diabetes were defined as the presence of a diagnosis of CVD or diabetes during the follow-up period in patients without prior event. RESULTS: The age and sex standardized incidence rate of CVD was 13.5 per 1000 patient-year in the patients with any psychiatric disorder versus 6.3 per 1000 patient-year in the controls. A similar trend was observed for incident diabetes (5.7 versus 3.4 per 1000 patient-year, respectively). The bipolar disorder and the schizophrenia cohorts showed the highest standardized incidence rates. CONCLUSION: Incidence of CVD and to a lesser extent type-2-diabetes was particularly high in patients with psychiatric disorders. This carries strong clinical implications for the prevention of CVD and type-2-diabetes in these patients.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Registros Electrónicos de Salud/tendencias , Trastornos Mentales/epidemiología , Sistema de Registros , Adulto , Enfermedades Cardiovasculares/diagnóstico , Estudios de Cohortes , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estudios Longitudinales , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Vigilancia de la Población/métodos , Factores de Riesgo , Suecia/epidemiología , Adulto JovenRESUMEN
Patients with schizophrenia have a higher mortality than the general population. The risk of obesity, diabetes mellitus and cardiovascular disease is twice as high as in people without psychotic disorders. There are differences in emergency care as well as in secondary prevention in cardiovascular disorders and diabetes. The reason for the increased morbidity and mortality is most likely both inadequate diagnostic procedures and inadequate treatment interventions. Pharmacologic antipsychotic treatment can have negative metabolic side effects. Guidelines for identifying metabolic effects are described. Psychiatrists are advised to collaborate with specialists in internal medicine, paediatrics or general practice.
Asunto(s)
Trastornos Psicóticos/mortalidad , Antipsicóticos/efectos adversos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/terapia , Comorbilidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Diabetes Mellitus/metabolismo , Diabetes Mellitus/terapia , Humanos , Esperanza de Vida , Estilo de Vida , Obesidad/diagnóstico , Obesidad/epidemiología , Obesidad/metabolismo , Obesidad/terapia , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/metabolismo , Esquizofrenia/epidemiología , Esquizofrenia/metabolismo , Esquizofrenia/mortalidadRESUMEN
Individuals with severe psychiatric disorders are more likely than the population at large to develop metabolic derangements such as overweight and diabetes. Cardiovascular disease is also more frequently seen in this group. Contributing factors may include inappropriate diet or lack of physical activity, but antipsychotic medication may also play a role. Seven Swedish specialist medical societies have collaborated in formulating a set of concise clinically applicable guidelines-reproduced here in modified form-for the prevention and management of metabolic risk in this patient group. The importance of implementation is emphasized.
