Diagnostik metabolischer Risikofaktoren bei stationär-psychiatrischen Patienten^[*]

Zusammenfassung

Ziel: Überprüfung der Diagnosecodierung metabolischer Risikofaktoren (MR) bei psychisch kranken Patienten.

Methode: Anhand des „Versorgungsindikatoren in der Psychiatrie und Psychosomatik Datensatzes“ Beschreibung der Häufigkeit der Diagnosecodierung von MR.

Ergebnisse: Im Vergleich zu bekannten Prävalenzzahlen waren Adipositas (2,8 %), Nikotinabhängigkeit (4,2 %), Hyperlipidämien (2,8 %) deutlich, Diabetes (6,8 %) und arterielle Hypertonie (17,7 %) leicht unterdiagnostiziert.

Schlussfolgerung: MR sind bei psychiatrischen Patienten unzureichend dokumentiert, vermutlich auch unzureichend behandelt.

Abstract

Objective: Individuals suffering from mental illness have one to two decades reduced life expectancy. The increased morbidity and mortality is mainly due to cardiometabolic disorders. Despite these numbers, international studies give evidence that diagnoses and treatment of metabolic risk factors in psychiatric patients is insufficient. We assume that in Germany metabolic risk factors are also underdiagnosed and insufficiently treated.

Methods: We tested for the frequency of diagnoses of the metabolic risk factors obesity, nicotine dependence and abuse, disorders of lipid metabolism, hypertension and diabetes in 139 307 cases of residential treatment and semi-residential care in 47 psychiatric hospitals in Germany in the year 2012. Data were derived from the VIPP(indicators of treatment quality in psychiatry and psychosomatic medicine)-project, a project that comprises the routine data of psychiatric hospitals, that are sent to the InEK (institute for the lump sum payment system for hospitals). Frequencies were compared with prevalence of metabolic risk factors in the German population and prevalences of metabolic risk factors found in psychiatric patients in international studies.

Results: In particular obesity (2.8 %), disorders of lipid metabolism (2.8 %) and nicotin dependence (4.2 %) were underdiagnosed. We assume that also diabetes (6.8 %) and hypertension (17.7 %) were underdiagnosed.

Conclusion: The results give evidence that metabolic risk factors are underdiagnosed and possibly insufficiently treated in German psychiatric hospitals. We cannot exclude that the results might also be due to poor documentation. It remains to be seen if the introduction of the PEPP (the new lump sum payment system in German psychiatry) will heighten the level of attention for metabolic risk factors and their treatment.

Schlüsselwörter

metabolische Risikofaktoren - unterdiagnostiziert - psychiatrische Erkrankungen

Keywords

metabolic risk factors - underdiagnosed - psychiatric disorders

^* VIPP: Versorgungsrelevante Indikatoren in der Psychiatrie und Psychosomatik; Steuerungsgruppe: Frank Godemann (Sprecher), Claus Woff-Menzler (stellvertretender Sprecher), Florian Seemüller, Roland Nitschke, Michael Löhr, Hans-Joachim Salize (ZI-Mannheim), Iris Hauth (DGPPN), Gerhard Längle (Bundesdirektorenkonferenz), Arno Deister (ackpa)

• Literatur

• 1 Tiihonen J, Lonnqvist J, Wahlbeck K et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009; 374: 620-627
• 2 Scott D, Happell B. The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues Ment Health Nurs 2011; 32: 589-597
• 3 Batty GD, Hamer M, Der G. Does somatic illness explain the association between common mental disorder and elevated mortality? Findings from extended follow-up of study members in the UK Health and Lifestyle Survey. J Epidemiol Community Health 2012; 66: 647-649
• 4 Gale CR, Batty GD, Osborn DP et al. Association of mental disorders in early adulthood and later psychiatric hospital admissions and mortality in a cohort study of more than 1 million men. Arch Gen Psychiatry 2012; 69: 823-831
• 5 Stanley SH, Laugharne JD. Obesity, cardiovascular disease and type 2 diabetes in people with a mental illness: a need for primary health care. Aust J Prim Health 2012; 18: 258-264
• 6 Morden NE, Lai Z, Goodrich DE et al. Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia. Gen Hosp Psychiatry 2012; 34: 368-379
• 7 Dickerson FB, Brown CH, Daumit GL et al. Health status of individuals with serious mental illness. Schizophr Bull 2006; 32: 584-589
• 8 Hellerstein DJ, Almeida G, Devlin MJ et al. Assessing obesity and other related health problems of mentally ill Hispanic patients in an urban outpatient setting. Psychiatr Q 2007; 78: 171-181
• 9 Haw C, Bailey S. Body mass index and obesity in adolescents in a psychiatric medium secure service. J Hum Nutr Diet 2012; 25: 167-171
• 10 Heiskanen TH, Niskanen LK, Hintikka JJ et al. Metabolic syndrome and depression: a cross-sectional analysis. J Clin Psychiatry 2006; 67: 1422-1427
• 11 Grover S, Malhotra N, Chakrabarti S et al. Metabolic syndrome in bipolar disorders. Indian J Psychol Med 2012; 34: 110-118
• 12 Mitchell AJ, Vancampfort D, Sweers K et al. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders – a systematic review and meta-analysis. Schizophrenia bulletin 2013; 39: 306-318
• 13 Strassnig M, Brar JS, Ganguli R. Nutritional assessment of patients with schizophrenia: a preliminary study. Schizophr Bull 2003; 29: 393-397
• 14 Vancampfort D, Probst M, Scheewe T et al. Lack of physical activity during leisure time contributes to an impaired health related quality of life in patients with schizophrenia. Schizophr Res 2011; 129: 122-127
• 15 Tsatsoulis A, Fountoulakis S. The protective role of exercise on stress system dysregulation and comorbidities. Ann N Y Acad Sci 2006; 1083: 196-213
• 16 Tamashiro KL, Sakai RR, Shively CA et al. Chronic stress, metabolism, and metabolic syndrome. Stress 2011; 14: 468-474
• 17 Sorensen HJ, Nielsen PR, Benros ME et al. Somatic Diseases and Conditions Before the First Diagnosis of Schizophrenia: A Nationwide Population-based Cohort Study in More Than 900000 Individuals. Schizophrenia bulletin 2014;
• 18 Gragnoli C. Hypothesis of the neuroendocrine cortisol pathway gene role in the comorbidity of depression, type 2 diabetes, and metabolic syndrome. The application of clinical genetics 2014; 7: 43-53
• 19 Liu Y, Li Z, Zhang M et al. Exploring the pathogenetic association between schizophrenia and type 2 diabetes mellitus diseases based on pathway analysis. BMC medical genomics 2013; 6 (Suppl. 01) S17
• 20 Daumit GL, Dickerson FB, Wang NY et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med 2013; 368: 1594-1602
• 21 De Hert M, Cohen D, Bobes J et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011; 10: 138-151
• 22 De Hert M, Dekker JM, Wood D et al. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 2009; 24: 412-424
• 23 Buckley PF, Miller DD, Singer B et al. Clinicians’ recognition of the metabolic adverse effects of antipsychotic medications. Schizophr Res 2005; 79: 281-288
• 24 Mackin P, Bishop DR, Watkinson HM. A prospective study of monitoring practices for metabolic disease in antipsychotic-treated community psychiatric patients. BMC Psychiatry 2007; 7: 28
• 25 Haupt DW, Rosenblatt LC, Kim E et al. Prevalence and predictors of lipid and glucose monitoring in commercially insured patients treated with second-generation antipsychotic agents. Am J Psychiatry 2009; 166: 345-353
• 26 Mitchell AJ, Delaffon V, Vancampfort D et al. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med 2012; 42: 125-147
• 27 Godemann F, Falkai P, Hauth I et al. [Lump sum payment system in psychiatry and psychosomatics: concomitant research – quo vadis?]. Nervenarzt 2013; 84: 864-868
• 28 Swart E, Ihle P, Geyer S et al. [GPS – good practice secondary data analysis. Working Group for the Survey and Utilization of Secondary Data (AGENS) of the German Society for Social Medicine and Prevention (DGSMP)]. Gesundheitswesen 2005; 67: 416-421
• 29 Swart E, Gothe H, Geyer S et al. [Good Practice of Secondary Data Analysis (GPS): Guidelines and Recommendations]. Gesundheitswesen 2015; 77: 120-126
• 30 Mensink GB, Schienkiewitz A, Haftenberger M et al. [Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2013; 56: 786-794
• 31 Larsen JI, Andersen UA, Becker T et al. Cultural diversity in physical diseases among patients with mental illnesses. The Australian and New Zealand journal of psychiatry 2013; 47: 250-258
• 32 Coodin S. Body mass index in persons with schizophrenia. Can J Psychiatry 2001; 46: 549-555
• 33 McIntyre RS, Konarski JZ, Wilkins K et al. Obesity in bipolar disorder and major depressive disorder: results from a national community health survey on mental health and well-being. Can Psychiatry 2006; 51: 274-280
• 34 Lampert T. Tabak – Zahlen und Fakten zum Konsum. Jahrbuch Sucht 2014. Hamm: Deutsche Hauptstelle für Suchtfragen; 2014
• 35 Schulz M, Topper M, Behrens J. [Smoking habits of employees and patients in the psychiatric department of a general hospital]. Gesundheitswesen (Bundesverband der Ärzte des Öffentlichen Gesundheitsdienstes (Germany)) 2004; 66: 107-113
• 36 Davidson S, Judd F, Jolley D et al. Cardiovascular risk factors for people with mental illness. Aust N Z J Psychiatry 2001; 35: 196-202
• 37 Gutierrez-Rojas L, Azanza JR, Bernardo M et al. Prevalence of Metabolic Syndrome in Spanish Patients with Schizophrenia and Overweight. The CRESSOB Study. Actas Esp Psiquiatr 2014; 42: 9-17
• 38 Nasrallah HA, Meyer JM, Goff DC et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res 2006; 86: 15-22
• 39 De Hert MA, van Winkel R, Van Eyck D et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res 2006; 83: 87-93
• 40 Koster I, Schubert I, Huppertz E. [Follow-up of the CoDiM-Study: Cost of diabetes mellitus 2000 – 2009]. Deutsche medizinische Wochenschrift (1946) 2012; 137: 1013-1016
• 41 Deutsche Diabetesgesellschaft. Der deutsche Diabetes-Gesundheitsbericht 2013. Im Internet: http://www.diabetesde.org/fileadmin/users/Patientenseite/PDFs_und_TEXTE/Infomaterial/Diabetes_Gesundheitsbericht_2013.pdf (Stand:17.02.2015)
• 42 McIntyre RS, Konarski JZ, Misener VL et al. Bipolar disorder and diabetes mellitus: epidemiology, etiology, and treatment implications. Ann Clin Psychiatry 2005; 17: 83-93
• 43 van Winkel R, De Hert M, Van Eyck D et al. Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: evaluation of incidence and screening methods. J Clin Psychiatry 2006; 67: 1493-1500
• 44 Busch AM, Whited MC, Appelhans BM et al. Reliable change in depression during behavioral weight loss treatment among women with major depression. Obesity (SilverSpring) 2013; 21: E211-E218
• 45 Mezuk B, Eaton WW, Albrecht S et al. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008; 31: 2383-2390
• 46 Deuschle M, Paul F, Brosz M et al. Assessment of cardiovascular disease risk in patients with schizophrenia spectrum disorders in German psychiatric hospitals: results of the pharmacoepidemiologic CATS study. SocPsychiatry PsychiatrEpidemiol 2013; 48: 1283-1288
• 47 [Anonym] Weltgesundheitstag 2013 steht unter dem Motto „Hypertonie“. Epidemiologisches Bulletin 2013; 13: 105-106
• 48 Meng L, Chen D, Yang Y et al. Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens 2012; 30: 842-851
• 49 Fagiolini A, Kupfer DJ, Houck PR et al. Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry 2003; 160: 112-117
• 50 Cerimele JM, Katon WJ. Associations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: a systematic review. Gen Hosp Psychiatry 2013; 35: 16-22
• 51 Hamer M, Batty GD, Kivimaki M. Risk of future depression in people who are obese but metabolically healthy: the English longitudinal study of ageing. MolPsychiatry 2012; 17: 940-945
• 52 Dodd S, Brnabic AJ, Berk L et al. A prospective study of the impact of smoking on outcomes in bipolar and schizoaffective disorder. Compr Psychiatry 2010; 51: 504-509
• 53 Wang CY, Xiang YT, Weng YZ et al. Cigarette smoking in patients with schizophrenia in China: prospective, multicentre study. Aust N Z J Psychiatry 2010; 44: 456-462
• 54 Kotov R, Guey LT, Bromet EJ et al. Smoking in schizophrenia: diagnostic specificity, symptom correlates, and illness severity. Schizophr Bull 2010; 36: 173-181
• 55 Haslemo T, Eikeseth PH, Tanum L et al. The effect of variable cigarette consumption on the interaction with clozapine and olanzapine. European journal of clinical pharmacology 2006; 62: 1049-1053
• 56 Manu P, Khan S, Radhakrishnan R et al. Body mass index identified as an independent predictor of psychiatric readmission. The Journal of clinical psychiatry 2014; 75: e573-577
• 57 Colenda CC, Trinkle D, Hamer RM et al. Hospital utilization and readmission rates for geriatric and young adult patients with major depression: results from a historical cohort study. Journal of geriatric psychiatry and neurology 1991; 4: 166-172
• 58 Chaiton M, Cohen JE, Rehm J et al. Confounders or intermediate variables? Testing mechanisms for the relationship between depression and smoking in a longitudinal cohort study. Addictive behaviors 2015; 42: 154-161
• 59 van Schayck OC, Pinnock H, Ostrem A et al. IPCRG Consensus statement: tackling the smoking epidemic – practical guidance for primary care. Primary care respiratory journal: journal of the General Practice Airways Group 2008; 17: 185-193
• 60 Currie SR, Karltyn J, Lussier D et al. Outcome from a community-based smoking cessation program for persons with serious mental illness. Community mental health journal 2008; 44: 187-194