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Co-morbidity in the Severely Mentally Ill: Cardiometabolic Risk Factors, Prevention and Intervention

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Advances in Psychiatry

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Abstract

Co-morbidity represents one of the greatest challenges for twenty-first-century medicine. A high prevalence of co-morbidity in the severely mentally ill (SMI) has been well established leading to a significant impact on quality of life, life expectancy and premature death by 15–20 years. The major recognised contributor to excess death is cardiovascular disease.

Known risk factors include smoking, obesity, alcohol and drug misuse and diabetes. The field of knowledge of the linkage between common psychiatric disorders and cardiometabolic risk is growing with a focus on common pathophysiological and inflammatory processes in addition to the already well-recognised cluster of risk factors which have been described in the past as ‘metabolic syndrome’.

International/national guidelines and consensus statements provide the guidance and evidence to optimise screening for and management of risk factors with increasing emphasis on early intervention with lifestyle changes and treatment review.

In this chapter, we have prepared a narrative review of the relevant literature complimented by the authors’ experience of providing holistic care for the SMI. Also we refer to the evidence for shared pathophysiological mechanisms and cardiometabolic risk factors contributing to the high levels of co-morbidity in this population. Finally we make recommendations for screening and treatment outlining effective interventions to improve quality of life and life expectancy.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, The Carseview Centre, Dundee, Scotland, UK

    H. L. Millar

  2. Division of Alcohol and Drug Abuse: Treatment and Research, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA

    I. Salloum

  3. St George’s, University of London, London, UK

    M. T. Abou-Saleh

Authors
  1. H. L. Millar
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  2. I. Salloum
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  3. M. T. Abou-Saleh
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Editor information

Editors and Affiliations

  1. The Medical Centre, Nuneaton, United Kingdom

    Afzal Javed

  2. Division of Neuroscience Medicine, Aristotle University, Division of Neuroscience Medicine, Thessaloniki, Greece

    Kostas N. Fountoulakis

Appendix 1: Metabolic Syndrome Diagnostic Criteria

Adapted from: Kassi et al. Metabolic syndrome: definitions and controversies. BMC Medicine 2011 9 :48 doi:https://doi.org/10.1186/1741-7015-9-48 www.biomedcentral.com

Appendix 1: Metabolic Syndrome Diagnostic Criteria

5.1.1 Criteria for Metabolic Syndrome (MetS) Definitions in Adults

5.1.1.1 World Health Organization Criteria (1998)

Insulin resistance is defined as type 2 diabetes mellitus (DM) or impaired fasting glucose (IFG) (>100 mg/dL) or impaired glucose tolerance (IGT), plus two of the following:

  • Abdominal obesity (waist-to-hip ratio >0.9 in men or >0.85 in women, or body mass index (BMI) > 30 kg/m2. There should only be a gap of one line only under this sentence in keeping with other bullet points. i.e. these are 4 consecutive bullet points.

  • Triglycerides 150 mg/dL or greater, and/or high-density lipoprotein (HDL)-cholesterol <40 mg/dL in men and <50 mg/dL in women.

  • Blood pressure (BP) 140/90 mmHg or greater.

  • Microalbuminuria (urinary albumin secretion rate 20 μg/min or greater, or albumin-to-creatinine ratio 30 mg/g or greater).

5.1.2 European Group for the Study of Insulin Resistance Criteria (1999)

Insulin resistance defined as insulin levels >75th percentile of non-diabetic patients, plus two of the following:

  • Waist circumference 94 cm or greater in men, 80 cm or greater in women.

  • Triglycerides 150 mg/dL or greater and/or HDL-cholesterol <39 mg/dL in men or women.

  • BP 140/90 mmHg or greater or taking antihypertensive drugs.

  • Fasting glucose 110 mg/dL or greater.

5.1.3 National Cholesterol Education Program Adult Treatment Panel III (NCEP:ATPIII) Criteria (2001)

Any three or more of the following:

  • Waist circumference >102 cm in men, >88 cm in women.

  • Triglycerides 150 mg/dL or greater.

  • HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women.

  • BP 130/85 mmHg or greater.

  • Fasting glucose 110 mg/dL* or greater.

* In 2003, the American Diabetes Association (ADA) changed the criteria for IFG tolerance from 110 to 100 mg/dL.

5.1.4 American Association of Clinical Endocrinology Criteria (2003)

IGT plus two or more of the following:

  • BMI 25 kg/m2 or greater.

  • Triglycerides 150 mg/dL or greater and/or HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women.

  • BP 130/85 mmHg or greater.

5.1.5 American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) Criteria (2004)

Any three of the following:

  • Waist circumference 102 cm or greater in men, 88 cm or greater in women.

  • Triglycerides 150 mg/dL or greater.

  • HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women.

  • BP 130/85 mmHg or greater (or use of medication for hypertension)

  • Fasting glucose 100 mg/dL or greater(or use of medication for hyperglycaemia)

5.1.6 International Diabetes Federation (IDF) Criteria (2005)

Central obesity (defined as waist circumference but can be assumed if BMI > 30 kg/m2) with ethnicity-specific values,* plus two of the following:

  • Triglycerides 150 mg/dL or greater.

  • HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women.

  • BP 130/85 mmHg or greater. (or use of medication for hypertension)

  • Fasting glucose 100 mg/dL or greater. (or use of medication for hyperglycaemia)

*To meet the criteria, waist circumference must be: for Europeans, >94 cm in men and >80 cm in women; and for South Asians, Chinese, and Japanese, >90 cm in men and >80 cm in women. For ethnic South and Central Americans, South Asian data are used, and for sub-Saharan Africans and Eastern Mediterranean and Middle East (Arab) populations, European data are used.

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Millar, H.L., Salloum, I., Abou-Saleh, M.T. (2019). Co-morbidity in the Severely Mentally Ill: Cardiometabolic Risk Factors, Prevention and Intervention. In: Javed, A., Fountoulakis, K. (eds) Advances in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-70554-5_5

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  • DOI: https://doi.org/10.1007/978-3-319-70554-5_5

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