title: BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment.
abstract: Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.
authors.affiliation: Professor of Psychiatry (Emeritus), Queen's University Belfast, UK Clinical Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK sjcooperqub@gmail.com.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Cooper
authors.affiliation: Professor (Emeritus), Queen's University Belfast, UK Honorary Professor of Neuroscience, Sheffield Hallam University, Sheffield, UK.
authors.forename: Gavin P
authors.initials: GP
authors.lastname: Reynolds
authors.affiliation: Professor of Psychiatry, The Centre for Mental Health, Imperial College London, London, UK.
authors.forename: Tre
authors.initials: T
authors.lastname: Barnes
authors.affiliation: General Practitioner, Laurie Pike Health Centre, Birmingham, UK.
authors.forename: E
authors.initials: E
authors.lastname: England
authors.affiliation: Honorary Clinical Professor of Psychiatry, University of Manchester, Manchester, UK Consultant Psychiatrist, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Haddad
authors.affiliation: Consultant Physician, Leighton and Macclesfield Hospitals, Cheshire, UK Research Fellow, University of Manchester, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Heald
authors.affiliation: Professor in Diabetes and Endocrinology, Human Development and Health Academic Unit, University of Southampton, Southampton, UK.
authors.forename: Rig
authors.initials: R
authors.lastname: Holt
authors.affiliation: Professor of Addiction Biology, Imperial College, London, UK Consultant Psychiatrist, CNWL NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Lingford-Hughes
authors.affiliation: Professor of Psychiatric Epidemiology and Honorary Consultant Psychiatrist, Division of Psychiatry UCL, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Osborn
authors.affiliation: Trainee in Psychiatry, Hairmyres Hospital, Glasgow, UK.
authors.forename: O
authors.initials: O
authors.lastname: McGowan
authors.affiliation: Honorary Senior Lecturer, King's College London, IOPPN, Department of Psychosis Studies PO68, London, UK.
authors.forename: M X
authors.initials: MX
authors.lastname: Patel
authors.affiliation: Chief Pharmacist, Oxleas NHS Foundation Trust, Dartford, UK Joint-Head, Prescribing Observatory for Mental Health, CCQI, Royal College of Psychiatrists, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Paton
authors.affiliation: Policy Manager, Rethink Mental Illness, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Reid
authors.affiliation: Primary Care Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Shiers
authors.affiliation: Professor of Early Intervention and Psychosis, University of Worcester, Worcester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Smith
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008659:Metabolic Diseases / Q000209:etiology / Q000628:therapy; D009765:Obesity / Q000209:etiology / Q000628:therapy; D050177:Overweight / Q000209:etiology / Q000628:therapy; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*; D015430:Weight Gain
chemical_list: D014150:Antipsychotic Agents
keywords: Alcohol misuse; antipsychotic; aripiprazole; cardiovascular disease; diabetes; dyslipidaemia; guidelines; interventions for weight gain; lifestyle; metformin; obesity; overweight; psychosis; risk assessment; schizophrenia; smoking cessation; switching