Physical Health in Individuals with a Psychotic Illness
Young people who are taking antipsychotic medication are at increased risk of weight gain and metabolic abnormalities, which may appear in the first few weeks of treatment and can lead to metabolic syndrome (insulin resistance, abdominal obesity, dyslipidemia, hyperglycemia, and hypertension).48,76,77 There are a range of reasons for this, such as genetic predisposition, poor nutrition, lack of exercise, smoking, and substance abuse, as well as the side effects of antipsychotic medication.76,77 Moreover, there is strong evidence to suggest that people with psychotic illnesses receive inferior quality physical health care compared to those with chronic physical illnesses.78 Apart from effects on physical health, the weight gain associated with antipsychotic treatment can affect a young person’s self-esteem, increase self-stigma, and increase the chances of the patient discontinuing medication, thus increasing the risk of relapse. Together, these factors mean that it is crucial to take measures to prevent and treat weight gain, preferably prior to its becoming an issue.
Monitoring of weight, waist circumference, blood glucose, and lipid levels is essential from the time that antipsychotics are initiated, with weight gain being assessed every week, or at least once every two weeks, for the first 8 weeks of treatment. Then, all parameters should be assessed every 3 months for the first year of treatment.78 Switching antipsychotic medication may be necessary for those who experience rapid and significant weight gain.79 Interventions promoting a healthy lifestyle and behavioral change are particularly important for young people and are generally well-accepted,78-80-81 and antidiabetic drugs may also be considered.
Finally, a pre-emptive approach is crucial to addressing the physical health needs of these young people and preventing the antipsychotic-induced metabolic disturbances that contribute so strongly to poor physical health before this becomes entrenched and a self-perpetuating cycle. Young people living with early psychosis have the same right to good physical health and good physical health care as their peers who have not experienced psychosis, and the medical community is responsible to help make this a reality.82