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Physical Health and People with a Severe Mental Illness

Physical Health and People with a Severe Mental Illness. Cardiovascular Disease. Learning Objectives. Clinical. Organizational. Communication with the mental health team is essential Sharing clinical information is essential

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Physical Health and People with a Severe Mental Illness

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  1. Physical Health and People with a Severe Mental Illness Cardiovascular Disease

  2. Learning Objectives Clinical Organizational Communication with the mental health team is essential Sharing clinical information is essential Primary care team members are essential – nursing, care coordination, dietitian, community care worker (when available) • Cardiovascular disease is more common • Diabetes is a significant risk factor • Smoking is a significant risk factor • Lifestyle factors are significant • Comorbidity is complex and cardiovascular risk significantly elevated

  3. Amir Clinical Background: • Amir is a 38 year old man • PMH: Schizophrenia diagnosed 22 years ago • Nil else significant • Family History: Both parents have diabetes • Smoking History: recently stopped smoking • Social History: no record of employment status

  4. Amir Issues for the Clinician Fact Sheet People with severe mental illness and CVD are more likely to Have diabetes Be overweight Smoke Have dyslipidemia Have erectile dysfunction and hyperprolactinemia • Cardiovascular disease is more common • Cardiovascular risk score assessment is needed • Lifestyle factors will need considering

  5. Amir The reason for the consultation: • Amir was recently discharged following a five month admission for schizophrenia. During this admission his medication was changed to clozapine • Following discharge he developed diabetes • He stopped smoking, and developed clozapine toxicity as the dose of the medication had not been reduced • He is attending today, for his first diabetic review

  6. Amir The consultation (path results): • BP: 150/95 • BMI: 44 • Smoke: stopped smoking • HbA1c: 80mmol/mol (9.5%) • Cholesterol: 7.5 mmol/L (290 mg/dL) • HDL Chol: 0.8 mmol/L (30.9 mg/dL) • Renal function: eGFR 70; • Prolactin: 3,256 mIU/L (normal range <450 mIU/L for men)

  7. Amir Issues for the Clinician Fact Sheet Antipsychotic medication induces risk factors for cardiovascular disease. Antipsychotic medication is also thrombophilic increasing the likelihood of DVT and PE Renal failure and erectile dysfunction are independent risk factors for cardiovascular disease • Cardiovascular risk score • QRISK2: 27% • Which are the most appropriate interventions to offer? • What would be the consequence of stopping clozapine? • Intervention for elevated prolactin? • Communication with the mental health team

  8. Learning Objectives Clinical Organizational Communication with the mental health team is essential Sharing clinical information is essential Primary care team members are essential – nursing, care coordination, dietitian, community care worker (when available) • Cardiovascular disease is more common • Diabetes is a significant risk factor • Smoking is a significant risk factor • Lifestyle factors are significant • Comorbidity is complex and cardiovascular risk significantly elevated

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