主催: The Japanese Pharmacological Society, The Japanese Society of Clinical Pharmacology
会議名: WCP2018 (18th World Congress of Basic and Clinical Pharmacology)
開催地: Kyoto
開催日: 2018/07/01 - 2018/07/06
People with schizophrenia have an average reduction in life expectancy of 14.5 years. This reduced life expectancy is due mainly to medical conditions, particularly cardiovascular diseases.
People with first episode psychosis are vulnerable to physical conditions even before they begin taking antipsychotic drugs. They have impaired glucose tolerance, and it has been suggested that schizophrenia and diabetes share genetically-determined inflammatory pathways. They have also been found to have subclinical dyslipidemia and nutritional deficiencies (vitamin D and folate). Young people who later become psychotic also tend to have lower levels of physical activity in adolescence.
Many antipsychotic drugs are associated with weight gain, and weight gain is more pronounced in antipsychotic-naive patients. Antipsychotic drugs can induce changes in appetite and food intake, most likely due to interactions with serotonergic, histaminic and dopaminergic receptors. Clozapine and olanzapine are the most obesogenic antipsychotics.
In our Australian studies, we found that people aged 18-34 with psychosis had, on average, 2 to 3 of 10 WHO-defined global health risk factors, most commonly poor diet, smoking tobacco, obesity and physical inactivity. Comparing people with psychosis with the general population, we found that even at age 25 years, people with psychosis had numerous significant indicators of cardiovascular risk including higher BMI, waist circumference, triglycerides, and diastolic blood pressure, and lower HDL-cholesterol. We also found that compared to matched controls, men aged 25-35 years with schizophrenia had significantly shorter telomeres, indicating accelerated aging even relatively early in the course of the illness.
It is essential that measures to reduce cardiovascular risk in people with psychosis begin early, when antipsychotics are first prescribed. These include selection of weight-neutral drugs, and lifestyle programs addressing diet, exercise, smoking and substance use
