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Increased Health Risks Linked to First-episode Psychosis

Researchers call for coordinated care to address risks – NIH-funded study

Press Release

Many patients with psychosis develop health risks associated with premature death early in the course of their mental illness, researchers have found.

Patients with schizophrenia are already known to have higher rates of premature death than the general population. The study found that elevated risks of heart disease and metabolic issues such as high blood sugar in people with first episode psychosis are due to an interaction of mental illness, unhealthy lifestyle behaviors and antipsychotic medications that may accelerate these risks.

Patients entered treatment with significant health concerns – including excess weight, smoking, and metabolic issues – despite an average age of only 24 years. The study identifies key opportunities for health care systems to improve the treatment of such patients with first episode psychosis. The research was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.

Christoph Correll, M.D., of The Zucker Hillside Hospital, Hofstra North Shore-Long Island Jewish School of Medicine, New York, and colleagues, report their findings on Oct. 8, 2014 in JAMA Psychiatry.

Recovery After an Initial Schizophrenia EpisodeThe study is among the first of several to report results from the Recovery After an Initial Schizophrenia Episode (RAISE) project, which was developed by NIMH to examine first episode psychosis before and after specialized treatment was offered in community settings.

The researchers studied nearly 400 individuals between the ages of 15 and 40 with first episode psychosis, who presented for treatment at 34 community-based clinics across 21 states.

The frequency of obesity was similar to the same age group in the general population. However, smoking and metabolic syndrome (a combination of conditions including obesity, high blood pressure, high blood sugar, and abnormal blood fats, such as cholesterol and triglycerides) were much more common. Frequencies of dyslipidemia (an abnormal amount of blood fats, such as cholesterol and triglycerides) and pre-hypertension in this relatively young group of study participants were at least as high as rates typically found in people 15-20 years older.

Notably, treatment with antipsychotic medication, even after brief exposure (participants’ average exposure was 47 days), was associated with an increased risk of metabolic syndrome, which is a major risk for future cardiovascular illness.

Researchers concluded that people with first episode psychosis need a team-based health care approach that combines psychiatric and general medical care to address the full range of needs. Patients need early interventions for psychiatric illness, lower-risk antipsychotic medications, routine monitoring, and smoking cessation programs to improve health and reduce healthcare expenditures.1

“Our results strongly suggest that clinicians need to pay much more attention to promoting physical health in people with severe mental illness,” said lead author Christoph Correll, M.D. “We need to routinely educate patients about healthy lifestyle behaviors, monitor physical health, choose lower risk treatments whenever possible, and manage issues as they arise. Without a combined physical and mental health care approach, we miss major opportunities to improve psychiatric as well as medical health in patients with schizophrenia and other severe conditions.”

Reference

1Correll CU, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA, Marcy P, Addington J, Estroff SE, Robinson J, Penn D, Azrin S, Goldstein A, Severe J, Heinssen R, Kane JM. Cardiometabolic Risk in First Episode Schizophrenia-Spectrum Disorder Patients: Baseline Results from the RAISE-ETP Study, JAMA Psychiatry, Oct. 8, 2014

Contract: HHSN-271-2009-00019C

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About The Recovery After an Initial Schizophrenia Episode (RAISE) project is a large-scale research initiative that began, in 2008. RAISE is comprised of two studies examining different aspects of coordinated specialty care treatments for people experiencing first episode psychosis. For more information, visit www.nimh.nih.gov/RAISE. For more information about NAVIGATE, visit https://raiseetp.org .

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website .