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Helping consumers add years to their lives, II: The metabolic syndrome monitoring protocol and other tools

March 4, 2011
by Jack Carney, DSW
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When the "second generation" or atypical neuroleptics (c.f. box below) were introduced into consumers' treatment regimens nearly 20 years ago, they were hailed by mental health practitioners as a significant treatment advance. They were expected to ameliorate schizophrenia's negative symptoms, i.e., withdrawal, apathy and anhedonia, and to effectively address the positive symptoms, principally hallucinations and delusions.

In contrast to their predecessor or "first generation" neuroleptics, they were not expected to inflict unpleasant or serious side effects on the persons prescribed them. At least as per the controlled studies conducted by the pharmaceutical companies to secure FDA approval.

2nd Generation Atypical Neuroleptics

Zyprexa (Olanzapine) *

Risperdal (Risperidone)

Seroquel (Quetiapine) *

Abilify (Aripiprazole)

Geodon (Ziprasidone)

Invega (Paliperodone)

Clozaril (Clozapine) *

 

* Very high risk as re Metabolic Syndrome

Unfortunately, as Bob Whitaker points out in "Anatomy of an Epidemic," these controlled studies were generally short-term in length and provided little evidence of the atypicals' serious side effects and the life-threatening consequences they posed. Accordingly, practitioners, particularly prescribing psychiatrists, were slow to connect the dots; and the weight gain and insulin resistance that have become hallmarks of clozaril, risperdal, seroquel and zyprexa speedily developed into the metabolic illnesses—diabetes, heart disease and related systemic ailments—that have reduced vulnerable consumers' life expectancy to 55 years of age.

Two long-term studies conducted early in the new century corroborated the foregoing. The results of the first, the CATIE study, "Clinical Antipsychotic Trials of Intervention Effectiveness," were published in September 2005 (Phase I outcomes) and April 2006 (Phase II). While CATIE, a controlled study, supported the effectiveness of Clozaril and Zyprexa in controlling psychotic symptoms, it also revealed the high incidence of diabetes (13 percent) and hypertension (27 percent) among its study subjects.

The second key study was that undertaken by the National Association of State Mental Health Program Directors and entitled "Morbidity and Mortality in People With Serious Mental Illness," with its results published in October 2006. An overview of Medicaid data from 16 states, it reached the dramatic conclusion that persons with serious mental illnesses prescribed atypicals died 25 years earlier than members of the general population.

Moreover, it specified that persons diagnosed with schizophrenia and suffering from diabetes had mortality rates 2.7 times higher than other Americans; from cardiovascular disease 2.3 times higher; from respiratory diseases 3.2 times higher; from infectious diseases 3.4 times higher.

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Nor does it help that far too many behavioral health providers do not see metabolic syndrome as their problem. Despite having full time nursing, I know of one provider that flatly refused to even consider the monitoring protocol. Wellness training is a non-starter if we can't even get providers on board.

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Jack Carney

Jack Carney

Jack Carney, DSW, is a practicing social worker with 42 years of experience in the field. He is...