Maladie cardiovasculaire et diabète chez les personnes atteintes d'une maladie mentale sévère 2ème partie : Evaluation du risque et stratégie de prise en charge
Scheen, André; Gillain, Benoit; De Hert, Marc
2010 • In Médecine des Maladies Métaboliques, 4 (2), p. 223-230
severe mental illness; metformin; lifestyle; bipolar disorder; depression; schizophrenia
Abstract :
[fr] Nous avons insisté, dans un premier article, sur le fait que les personnes souffrant de maladies mentales sévères telles que la schizophrénie, la dépression ou le trouble bipolaire sont en moins bonne santé physique et ont une espérance de vie moindre que la population générale. Ils sont notamment exposés à de multiples facteurs de risque métabolique et cardiovasculaire conduisant à une surmortalité coronarienne et cérébrovasculaire. Ces patients peuvent avoir un accès restreint à la médecine générale, avec des opportunités de dépistage et de prévention du risque cardiovasculaire inférieures à celles que l'on est en droit d’attendre dans une population non-psychiatrique.
L'European Psychiatric Association (EPA), soutenue par l'European Association for the Study of Diabetes (EASD) et l'European Society of Cardiology (ESC), a publié récemment une déclaration de position dans le but d'améliorer la prise en charge des patients atteints de maladies mentales sévères. L'intention est d'amorcer une coopération et une prise en charge partagée entre les différents professionnels de la santé et de sensibiliser les psychiatres et les médecins de première ligne qui s'occupent de patients souffrant de maladies mentales sévères au dépistage et au traitement des facteurs de risque cardiovasculaire et du diabète. Après avoir décrit l’épidémiologie des maladies cardiovasculaires et du diabète dans la population atteinte de maladies mentales sévères et analysé l’impact des médicaments psychotropes en termes de risques métabolique et cardiovasculaire dans une première publication, le présent article décrit comment évaluer le risque de maladies cardiovasculaires et donne des conseils quant à la prise en charge des facteurs de risque cardiovasculaire et du diabète dans cette population psychiatrique.
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Gillain, Benoit
De Hert, Marc
Language :
French
Title :
Maladie cardiovasculaire et diabète chez les personnes atteintes d'une maladie mentale sévère 2ème partie : Evaluation du risque et stratégie de prise en charge
Alternative titles :
[en] Cardiovascular disease and diabetes in patients with severe mental disease. 2nd part : Risk assessment and management strategy.
Publication date :
2010
Journal title :
Médecine des Maladies Métaboliques
ISSN :
1957-2557
eISSN :
2214-8477
Publisher :
Masson, Issy-les-Moulineaux, France
Volume :
4
Issue :
2
Pages :
223-230
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
We have pointed out, in a first paper, that people with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population.
The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) recently published a statement with the aim of improving the care of patients suffering from severe mental illness. The intention is to initiate cooperation and shared care between the different healthcare professionals and to increase the awareness of psychiatrists and primary care physicians caring for patients with severe mental illness to screen and treat cardiovascular risk factors and diabetes. After having described the epidemiology of cardiovascular disease and diabetes in the population with severe mental illness and the potential cardiometabolic consequences of psychotropic medications in a first paper, the present article explains how to evaluate the cardiovascular risk and gives recommendations concerning the appropriate management of cardiovascular risk factors and diabetes in the psychiatric population.
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