Antipsychotic Drugs Raise Heart Risks, ExpertsWarn

FRIDAY, Feb. 18 -- Doctors must not forget about the physical health of people with serious mental health disorders who take antipsychotic drugs, experts warn.

The authors of an editorial in the Feb. 19 issue of The Lancet noted that patients with severe mental illness live an average of 16 years less than people in the general population. Heart disease, not suicide, is the major cause of death in these patients and antipsychotic drugs are a factor.

A study published recently in the Archives of General Psychiatry found that patients who took an antipsychotic drug gained 11 to 13 pounds within six to eight weeks after they starting taking the drug.

"The combination of antipsychotic side effects with poor diet, physical inactivity, high rates of smoking and other factors associated with psychotic illness, together with socioeconomic deprivation, has a devastating effect on cardiometabolic health," according to the editorial.

"If existing antipsychotics are here to stay -- at least for the foreseeable future -- what can be done to ameliorate their effects and improve patients' cardiometabolic health?" the authors asked.

Sole responsibility for safeguarding the physical health of patients with serious mental health conditions often falls to primary care providers, but mental health teams need to take an active role in that care, the editorial suggests. For example, a patient's physical health should be assessed when they enter mental health care.

"A lack of training in physical health issues is worrying in psychiatric doctors and nurses alike. In view of the wealth of evidence about the interconnections between mental health, physical health and prescribed medication, postgraduate psychiatric training should prioritize up-to-date knowledge about evidence-based management of cardiometabolic disease," the authors wrote.

They concluded: "Antipsychotic drugs are a clear risk to cardiometabolic health. This risk is, all too often, a necessary one. But the trade-off between mental and physical well-being is one that no patient should be forced to make. The mind-body dichotomy is both outdated and dangerous. The price of good mental health must not be a lifetime of physical illness."

From Medscape Medical News > Psychiatry

Marijuana Use Precedes Psychotic Symptoms

Megan Brooks

Authors and Disclosures

March 3, 2011 — Smoking marijuana during adolescence or young adulthood can trigger psychotic symptoms, and continued use may increase the risk for psychotic disorder later in life, a longitudinal study suggests.

"Young people should be advised to be careful and consider that when it comes to using cannabis; frequent and continued use is especially detrimental to mental health," Rebecca Kuepper, research psychologist and PhD student at Maastricht University in the Netherlands, who worked on the study, told Medscape Medical News.

"There are indications that especially people who start using cannabis at an early age (<16 years) are likely to become chronic users and thereby increase their risk for mental health problems, such as psychotic symptoms," she added.

The study was published online March 1 in BMJ.

Unique Study Reveals Temporal Tie

Although prior studies have shown that smoking marijuana can increase the risk for psychotic symptoms, it had been unclear whether smoking marijuana precedes psychotic symptoms.

The new study, the researchers say, was uniquely designed to look specifically at the temporal association between incident cannabis use and incident psychotic symptoms.

For 10 years, the researchers tracked 1923 individuals from the general population of Germany, aged 14 to 24 years at baseline, who had no history of psychotic symptoms or cannabis use at baseline.

They found that those who started smoking cannabis during the study had roughly twice the chance of reporting psychotic symptoms during follow-up as those who remained cannabis free (adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 – 3.1; P = .021). This was true even after accounting for potentially confounding factors, such as age, sex, socioeconomic status, use of other drugs, and other psychiatric diagnoses.

The incidence rate of psychotic symptoms between baseline and 3.5 years was 31% in cannabis smokers vs 20% in nonsmokers; between 3.5 years and 8.4 years rates were 14% and 8%, respectively.

In addition, cannabis users who reported psychotic symptoms and continued to use cannabis were more apt to have their symptoms linger than those who stopped smoking it. Continued use of cannabis increased the risk for persistent psychotic symptoms more than 2-fold (adjusted OR, 2.2; 95% CI, 1.2 – 4.2; P = .016).

These results suggest that incident cannabis use increases the risk for the onset of psychotic symptoms "and, if used continuously, increases the risk that those symptoms will persist," Ms. Kuepper told Medscape Medical News.

Wayne Hall, PhD, of University of Queensland, Australia, and coauthor of a linked commentary, told Medscape Medical News that the pattern of results "makes it unlikely that cannabis use is a form of self-medication of psychotic symptoms and more likely to be a contributory cause of psychotic symptoms." In the study, psychotic experiences did not predict later cannabis use.

Biologically Plausible

A causal link between cannabis use and incident psychotic symptoms is biologically plausible, Dr. Hall and coauthor Louisa Degenhardt, PhD, of the Burnet Institute in Melbourne, Australia, point out in an accompanying commentary.

They cite double-blind provocation studies in which intravenous tetrahydrocannabinol provoked positive and negative psychotic symptoms in a dose-dependent manner in healthy volunteers and in people with schizophrenia.

Given the current findings and those of earlier studies, "it is likely that cannabis use precipitates schizophrenia in people who are vulnerable because of a personal or family history of schizophrenia," Dr. Hall and Dr. Degenhardt note.

"The major challenge," they write, "is to deter enough young people from using cannabis so that the prevalence of psychosis is reduced."

The study was funded in part by the German Ministry of Research, Education, and Technology. The study authors, Dr. Hall, and Dr. Degenhardt have disclosed no relevant financial relationships.

BMJ. Published online March 1, 2011.

.