Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease"

Transcription

1 Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease Professional Tool #1: Screening and Monitoring in a High-Risk Population: Questions and Answers

2 Overview of Cardiometabolic Risk in the Psychiatric Population Major psychiatric disorders, such as schizophrenia, bipolar disorder, and major depressive disorder, are associated with increased morbidity and mortality from a range of medical causes, including cardiovascular disease and diabetes mellitus. Recent data from multiple states during have demonstrated that patients with major psychiatric disorders die 25 to 30 years earlier than unaffected individuals, primarily as the result of premature cardiovascular disease. 1 Major mental illness is associated with elevated prevalence of key modifiable risk factors for cardiovascular disease and diabetes, including overweight/obesity, dyslipidemia, hyperglycemia, hypertension, and smoking. 2 The American Diabetes Association (ADA) is strongly committed to increasing awareness of the associations between key risk factors, diabetes, and cardiovascular disease (coronary heart disease and cerebrovascular disease), among professionals and the public alike. An example is the recent Cardiometabolic Risk Initiative, detailed on the ADA website (diabetes.org/cmr), which lists obesity, hypertension, high LDL cholesterol, low HDL cholesterol, smoking, and physical inactivity as Cardiometabolic Risk Factors. In addition to the direct threats to health presented by each of these factors, the risks of type 2 diabetes and of cardiovascular disease are strongly associated with the number of risk factors present in an individual. Patients with major psychiatric disorders may be confronted with multiple contributors to increased prevalence of these risk factors, including poor nutrition, physical inactivity, poverty, substance abuse, and adverse effects associated with certain psychotropic medications. 3,4

3 Overview of Risks Associated with Second-Generation Antipsychotics The availability of second-generation antipsychotic drugs (SGAs; also known as atypical antipsychotics ) has facilitated effective treatment of psychotic disorders while reducing the risk of extrapyramidal side effects. In addition to their indicated use in schizophrenia and other psychotic disorders, SGAs are also often used in the management of depression with psychotic features, other psychiatric disorders, behavioral disturbances of dementia, and increasingly, in the treatment of psychiatric disorders in children and adolescents. 5 Recent evidence has identified an association between the use of specific SGAs and elevated risk for dyslipidemia, weight gain, obesity, prediabetes, and type 2 diabetes. A similar association has been identified for the earlier first-generation antipsychotics (FGAs). 3 Although previous case-control and epidemiological studies suggested elevated risk for obesity, impaired fasting glucose, and diabetes among patients with psychiatric disorders, evidence from clinical trials and other randomized controlled studies have also demonstrated additional risk associated with the use of these medications. 3,6,7,8 A 2004 American Diabetes Association (ADA) Consensus Development Conference concluded that certain SGAs are associated with the potential for rapid weight gain, deterioration in lipoprotein profile and increased risk of type 2 diabetes. Although the mechanisms underlying these effects remain incompletely understood, these potential side effects are of significant concern because of the association between these adverse cardiometabolic events and risk for diabetes and premature cardiovascular mortality. 1,4,8 Patients with major mental illness can benefit from the services of multidisciplinary team of health care professionals, including a primary care provider and a psychiatrist. However, a substantial number of patients lack access to key resources, including

4 primary care physicians (PCPs). Therefore, psychiatrists are often in the position of being the sole physician caring for their patients, who may require regular monitoring attention for both their psychiatric disorder and comorbid medical conditions. The increased cardiometabolic risks associated with psychiatric disorders and the medications used to treat them highlight the need for all members of the health care team to be aware of these risks, especially the psychiatrist who in many cases is the physician with the highest frequency of patient contact. 9 In addition, the psychiatrist may be well positioned to lead a team of qualified professionals, who may include the primary care physician or appropriate specialist, case manager, psychiatric nurse, dietitian, certified diabetes educator, ophthalmologist, podiatrist, and others. The team leader should coordinate a treatment plan individualized to the patient s specific needs and resources, and should facilitate a high degree of intercommunication among team members. For example, the psychiatrist is in an excellent position to advise other team members regarding the management of psychiatric symptoms that may interfere with the patient s capacity for self-care education and treatment. It is essential for the psychiatrist or other team leaders to provide or refer the patient for routine screening of cardiometabolic risk factors. Regardless of the site or setting of such screening, the psychiatrist needs to be aware of the results of screening and ongoing monitoring, so that the patient s risk profile and any adverse events are considered in the development and ongoing modification to the individualized treatment plan. Psychiatrists should know when to consider a change in treatment regimens incorporating antipsychotic medications, and when to provide referral(s) to a qualified PCP or specialist for diagnosis and treatment.

5 The ADA Consensus Development Conference developed a set of recommendations for screening and monitoring of patients receiving SGAs; this toolkit addresses these recommendations in a question-and-answer format. 8 Questions/Answers Q: Should all patients receiving antipsychotic medications be screened and monitored for obesity, dyslipidemia and type 2 diabetes risk? A: Yes although the risk of weight gain and type 2 diabetes appears to differ between agents (see below), any patient being initiated on antipsychotic therapy should first be screened for overweight and obesity, dyslipidemia and hyperglycemia, hypertension, and personal or family history of cardiometabolic disease or risk. While being treated with antipsychotic medications the patient should be monitored for treatment-emergent changes in weight, waist circumference, plasma lipid and glucose levels, and acute symptoms of diabetes (e.g., polyuria, polydipsia). Q: Are all antipsychotics associated with increased risk of obesity and type 2 diabetes? A: The Consensus Development Conference report in 2004 concluded that clozapine and olanzapine were associated with the greatest risk for weight gain; risperidone and quetiapine were associated with lower but intermediate risk, and aripiprazole and ziprasidone with the lowest risk. Clozapine and olanzapine were also

6 associated with increased risk for diabetes and dyslipidemia. Discrepant results in the published literature prevented the development of firm conclusions regarding the risk of diabetes and dyslipidemia associated with risperidone and quetiapine, and there was no clear evidence for increased risk (or no clear effect on risk) associated with aripiprazole and ziprasidone. However, any treatment condition associated with substantial increases in body weight could lead to an increase in risk for diabetes. Q: How should patients be assessed prior to initiating antipsychotic treatment? A: Baseline assessment of any patient being considered for antipsychotic treatment should include a complete individual and family history, a physical exam, measurement of weight and height, and calculation of body mass index (BMI), waist circumference (measured perpendicular to the top of the iliac crest; a spring-loaded biometric tape measure may be especially useful), blood pressure, fasting plasma glucose (FPG)*, and fasting lipid profile (A1c has recently been recommended as a screening or diagnostic tool 10 ). All values should be recorded for comparison against follow-up evaluations. The results of baseline assessment, especially when prediabetes, diabetes, dyslipidemia, or other cardiometabolic risks are uncovered, may influence the selection of antipsychotic agents; agents with a lower propensity for weight gain and lower risk for dyslipidemia and type 2 diabetes may be preferred in this situation. *Fasting (no food, gum or drink except tap water) should be for a minimum of 8 hrs.

7 Q: What if pretreatment screening reveals type 2 diabetes, or other cardiometabolic risk factors? A: Conditions should be treated according to current ADA standards of care. The 2010 Standards of Care executive summary pdf is included in this set of toolkits and can also be found at: Q: What follow-up assessments are most important? A: After initiating a new antipsychotic treatment or switching treatments, it is especially important to monitor body weight closely. The ADA recommends reassessment 4 weeks, 8 weeks, and 12 weeks after starting a new antipsychotic, and quarterly thereafter. The detailed monitoring schedules for body weight and other metabolic parameters from the ADA Consensus Development Conference are summarized in the adapted table below: 8 Assessment(s) Baseline Quarterly Annually weeks weeks weeks Personal/family history; physical X X exam Weight (BMI)/ Height X X X X X X Waist Circumference X X Blood Pressure X X X Fasting Plasma Glucose/ A1C X X X Fasting Lipid Profile X X X

8 Q: What clinical findings should prompt the treating physician to consider as a switch to an alternative antipsychotic medication and/or a referral to a qualified primary care provider or specialist? A: An increase in body weight from baseline of 5% or greater at any time during antipsychotic treatment should prompt the treating physician to consider a switch to another antipsychotic medication, if possible; guidelines for such a switch are provided in the ADA Consensus statement. 8 In general, cross-titration is recommended by the consensus panel as the safest approach, with a caution about abrupt discontinuation of any antipsychotic drug. The patient should be monitored closely during the switch process for worsening psychiatric symptoms. If the patient develops dyslipidemia or worsening glycemia at any time while receiving an antipsychotic medication, the treating physician should consider a switch to an antipsychotic associated with a lower risk of weight gain, dyslipidemia and diabetes. In addition, for those patients who develop diabetes or experience a worsening of pre-existing diabetes, the patient should be referred to a qualified clinician with extensive experience in managing patients with diabetes. Patients presenting with prediabetes or diabetes, as well as their identified caregivers, should also be referred to a recognized ADA Diabetes Self-Management Education Program capable of considering the individual needs of persons with major mental illness. The ADA patient and

9 professional toolkit materials are available to all health care professionals working with this special patient population, and should be employed as needed. Q; What information should be provided to patients and their families? A: Prior to initiating antipsychotic treatment, patients and family members should be counseled on the potential for weight gain and increased risk of dyslipidemia and type 2 diabetes associated with such treatment. In particular, the prescribing clinician should ensure that the acute signs and symptoms of type 2 diabetes (including polyuria, polydipsia, unexplained weight loss, and blurred vision), and those of hyperosmolar non-ketotic syndrome and diabetic ketoacidosis, as well as the need for regular follow-up monitoring, are adequately stressed.

10 References 1. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public health clients in eight states. Prev Chron Dis 2006;3 (April):1-14. Available at: Accessed August 21, McEvoy JP, Meyer JM, Goff DC, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res 2005; 80: Newcomer JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs 2005; 19 Suppl 1: Newcomer JW and Hennekens C. Severe Mental Illness and Risk of Cardiovascular Disease. JAMA; 298: Olfson M, Blanco C, Liu L, et al. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 2006; 63: Ryan MC, Collins P, Thakore JH. Impaired fasting glucose tolerance in firstepisode, drug-naive patients with schizophrenia. Am J Psychiatry 2003; 160: Dixon L, Weiden P, Delahanty J, et al. Prevalence and correlates of diabetes in national schizophrenia samples. Schizophr Bull 2000; 26: Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27: Improving the quality of health care for mental and substance-abuse conditions: Quality chasm series. Board on Healthcare Services, Institute of Medicine, Washington, DC: The National Academies Press.

11 10. International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care 2009; 32:

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität

More information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and type 1 diabetes mellitus History: A 15-year-old girl is seen in the endocrinology clinic for a routine follow-up visit for type 1 diabetes. She was diagnosed with diabetes at 12 years

More information

HEDIS CY2012 New Measures

HEDIS CY2012 New Measures HEDIS CY2012 New Measures TECHNICAL CONSIDERATIONS FOR NEW MEASURES The NCQA Committee on Performance Measurement (CPM) approved five new measures for HEDIS 2013 (CY2012). These measures provide feasible

More information

More than We Bargained For: Metabolic Side Effects of Antipsychotic Medications

More than We Bargained For: Metabolic Side Effects of Antipsychotic Medications More than We Bargained For: Metabolic Side Effects of Antipsychotic Medications Michael D. Jibson, MD, PhD Professor of Psychiatry University of Michigan Disclosure In the past 12 months I have received

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information

Screening for metabolic syndrome in addiction care; quick, reliable and non invasive

Screening for metabolic syndrome in addiction care; quick, reliable and non invasive Matthew Flynn 1 Screening for metabolic syndrome in addiction care; quick, reliable and non invasive A quantitative study into the effectiveness of waist circumference and blood pressure measurements as

More information

Aetna Behavioral Health

Aetna Behavioral Health Quality health plans & benefits Healthier living Financial well-being Intelligent solutions July 2014 Aetna Behavioral Health Quality Management Bulletin Inside this issue Three key elements of a behavioral

More information

Det metaboliske Syndrom Hvad er risikoen hos patienter? Hvad gør NIP skizofreni på området?

Det metaboliske Syndrom Hvad er risikoen hos patienter? Hvad gør NIP skizofreni på området? Det metaboliske Syndrom Hvad er risikoen hos patienter? Hvad gør NIP skizofreni på området? Henrik Lublin Centerchef, dr.med. Psykiatrisk Center Glostrup Increased Mortality Rates for Medical Disorders

More information

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D.

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D. TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type

More information

VI.2 Elements for a Public Summary

VI.2 Elements for a Public Summary VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Bipolar I Disorder Reported prevalence rates for bipolar I disorder differ due to local variations in psychiatric practice, variations

More information

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group Learning Objectives To accurately make the diagnosis of pre-diabetes/metabolic syndrome To understand the prevalence

More information

METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS

METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS Andrew M. Cislo, PhD Megan J. Ehret, PharmD, MS, BCPP Robert L. Trestman, MD, PhD Kirsten Shea, MBA www.uchc.edu Background Metabolic

More information

North of Tyne Area Prescribing Committee

North of Tyne Area Prescribing Committee North of Tyne Area Prescribing Committee ANTIPSYCHOTICS IN PSYCHOSIS, BIPOLAR DISORDER AND AUGMENTATION THERAPY IN TREATMENT RESISTANT DEPRESSION Information for Primary Care Updated November 2013 This

More information

Clinical Practice Guidelines for Diabetes Management

Clinical Practice Guidelines for Diabetes Management Clinical Practice Guidelines for Diabetes Management Diabetes is a disease in which blood glucose levels are above normal. Over the years, high blood glucose damages nerves and blood vessels, which can

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

I. The Positive Symptoms...Page 2. The Negative Symptoms...Page 2. Primary Psychiatric Conditions...Page 2

I. The Positive Symptoms...Page 2. The Negative Symptoms...Page 2. Primary Psychiatric Conditions...Page 2 SUTTER PHYSICIANS ALLIANCE (SPA) 2800 L Street, 7 th Floor Sacramento, CA 95816 SPA PCP Treatment & Referral Guideline Assessment & Treatment of Psychosis Developed March 1, 2003 Revised September 21,

More information

Population Health Management Program

Population Health Management Program Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care

More information

2. The prescribing clinician will register with the designated manufacturer.

2. The prescribing clinician will register with the designated manufacturer. Clozapine Management Program Description Magellan of Arizona Pharmacy Program Background: Magellan Health Services of Arizona recognizes the importance of a clozapine program. Clozapine received increased

More information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and type 2 diabetes mellitus History: A 17-year-old Hispanic female patient is seen for a routine clinic follow-up visit. She was diagnosed with type 2 diabetes 6 months ago. Her hemoglobin

More information

Cholesterol - New Guidelines and Treatment Protocols

Cholesterol - New Guidelines and Treatment Protocols Cholesterol - New Guidelines and Treatment Protocols By: James L. Holly, MD The New Year brings new opportunities to improve our health. Many of us receive gifts which we can't use because there's too

More information

Approved: New Requirements for Residential and Outpatient Eating Disorders Programs

Approved: New Requirements for Residential and Outpatient Eating Disorders Programs Approved: New Requirements for Residential and Outpatient Eating Disorders Programs Effective July 1, 2016, for Behavioral Health Care Accreditation Program The Joint Commission added several new requirements

More information

Addressing the Balance:

Addressing the Balance: Addressing the Balance: Physical Health Monitoring in an Early Intervention Service Gale Robinson Dan Kentley Sam McAvoy The fact that people with severe mental illness die twenty years earlier than the

More information

Diagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders.

Diagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders. Page 1 of 6 Approved: Mary Engrav, MD Date: 05/27/2015 Description: Eating disorders are illnesses having to do with disturbances in eating behaviors, especially the consuming of food in inappropriate

More information

ATYPICALS ANTIPSYCHOTIC MEDICATIONS

ATYPICALS ANTIPSYCHOTIC MEDICATIONS The atypical antipsychotics are a class of drugs that are used to treat a number of behavioral health disorders, including schizophrenia, other psychotic disorders, mood disorders, and behavioral agitation

More information

Prepublication Requirements

Prepublication Requirements Issued Prepublication Requirements The Joint Commission has approved the following revisions for prepublication. While revised requirements are published in the semiannual updates to the print manuals

More information

Psychotic Disorder. Psychosis. Psychoses may be caused by: Examples of Hallucinations and Delusions 12/12/2012

Psychotic Disorder. Psychosis. Psychoses may be caused by: Examples of Hallucinations and Delusions 12/12/2012 Psychosis Psychotic Disorder Dr Lim Boon Leng Psychiatrist and Medical Director Dr BL Lim Centre For Psychological Wellness Tel: 64796456 Email: info@psywellness.com.sg Web: www.psywellness.com.sg A condition

More information

Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management

Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management Richard IG Holt Human Development and Health Academic Unit, Faculty of Medicine,

More information

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease Diabetes, prediabetes and cardiovascular disease Classes of recommendations Levels of evidence Recommended treatment targets for patients with diabetes and CAD Definition, classification and screening

More information

Marc De Hert, M.D. Ph.D., Professor Psychiatry, UPC KU Leuven, Campus Kortenberg, Leuvense Steenweg 517, B-3070 Kortenberg, Belgium

Marc De Hert, M.D. Ph.D., Professor Psychiatry, UPC KU Leuven, Campus Kortenberg, Leuvense Steenweg 517, B-3070 Kortenberg, Belgium METABOLIC SYNDROME IN PEOPLE WITH SEVERE MENTAL ILLNESS Introduction Marc De Hert, M.D. Ph.D., Professor Psychiatry, UPC KU Leuven, Campus Kortenberg, Leuvense Steenweg 517, B-3070 Kortenberg, Belgium

More information

Provider Manual. Section 18.0 - Case Management and Disease Management

Provider Manual. Section 18.0 - Case Management and Disease Management Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute

More information

The Maryland Public Behavioral Health System

The Maryland Public Behavioral Health System The Maryland Public Behavioral Health System Arleen Rogan, Ph.D. Division Director, Integrated Health Services Family Services, Inc. Arleen.rogan@fs-inc.org Behavioral Health includes: Mental health conditions

More information

BEST PRACTICE ADHERENCE WITH ANTIPSYCHOTIC MEDICATION TREATMENT

BEST PRACTICE ADHERENCE WITH ANTIPSYCHOTIC MEDICATION TREATMENT BEST PRACTICE ADHERENCE WITH ANTIPSYCHOTIC MEDICATION TREATMENT David C. Rettew, M.D. Associate Professor of Psychiatry and Pediatrics Director, Pediatric Psychiatry Clinic Director, Child Psychiatry Fellowship

More information

Emergency Room Treatment of Psychosis

Emergency Room Treatment of Psychosis OVERVIEW The term Lewy body dementias (LBD) represents two clinical entities dementia with Lewy bodies (DLB) and Parkinson s disease dementia (PDD). While the temporal sequence of symptoms is different

More information

Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease

Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease Patient Tool #1 Understanding Diabetes and Psychiatric Illness: A Guide for Individuals, Families, and Caregivers Type 2 Diabetes,

More information

Trends in Prescribing of Antipsychotic Drugs in General Practice in England (Chart 1) 2.0. Other second generation antipsychotics (SGA)

Trends in Prescribing of Antipsychotic Drugs in General Practice in England (Chart 1) 2.0. Other second generation antipsychotics (SGA) Antipsychotic drugs Antipsychotics can be broadly classified into first generation antipsychotics (FGAs, formerly known as typical antipsychotics) and second generation antipsychotics (SGAs, formerly known

More information

Improving cardiometabolic health in Major Mental Illness

Improving cardiometabolic health in Major Mental Illness Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic

More information

SECOND-GENERATION ANTIPSYCHOTIC DRUG USE AMONG MEDICAID-ENROLLED CHILDREN: QUALITY-OF-CARE CONCERNS

SECOND-GENERATION ANTIPSYCHOTIC DRUG USE AMONG MEDICAID-ENROLLED CHILDREN: QUALITY-OF-CARE CONCERNS Department of Health and Human Services OFFICE OF INSPECTOR GENERAL SECOND-GENERATION ANTIPSYCHOTIC DRUG USE AMONG MEDICAID-ENROLLED CHILDREN: QUALITY-OF-CARE CONCERNS Daniel R. Levinson Inspector General

More information

Below, this letter outlines [patient name] s medical history, prognosis, and treatment rationale.

Below, this letter outlines [patient name] s medical history, prognosis, and treatment rationale. [Date] [Name of Contact] [Title] [Name of Health Insurance Company] [Address] [City, State, Zip Code] Insured: [Patient Name] Policy Number: [Number] Group Number: [Number] Diagnosis: [Diagnosis and ICD-9-CM

More information

Atypical antipsychotics and the metabolic syndrome. Thomas R. Dekoj, MS3 UIC College of Medicine

Atypical antipsychotics and the metabolic syndrome. Thomas R. Dekoj, MS3 UIC College of Medicine Atypical antipsychotics and the metabolic syndrome Thomas R. Dekoj, MS3 UIC College of Medicine Antipsychotic uses Schizophrenia and related d/o ~1% Bipolar ~2% used widely in schizophrenia spectrum d/o,

More information

Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.

Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant

More information

Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012

Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012 Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012 In 2002, SETMA began a relationship with Joslin Diabetes

More information

Breaking Down the Barriers - Masterclass training package and modules

Breaking Down the Barriers - Masterclass training package and modules Breaking Down the Barriers - Masterclass training package and modules Assessment of a patient with urgent mental health needs in an emergency department Module 1 Module 2 Mental health awareness training

More information

Mental Health Disorders in Alberta

Mental Health Disorders in Alberta Chapter 9 and Mental Health Disorders in Alberta Lauren C. Bresee Larry W. Svenson Scott B. Patten ALBERTA DIABETES ATLAS 9 175 176 ALBERTA DIABETES ATLAS 9 DIABETES AND MENTAL HEALTH DISORDERS IN ALBERTA

More information

Obesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000

Obesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 P F I Z E R F A C T S Obesity in the United States Workforce Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 p p Obesity in The United States Workforce One

More information

Psychotropic Drug Induced Metabolic Disorders

Psychotropic Drug Induced Metabolic Disorders DELHI PSYCHIATRY JOURNAL Vol. 10 No.1 APRIL 2007 Review Article Psychotropic Drug Induced Metabolic Disorders J.K. Trivedi, Kumar Gaurav Department of Psychiatry, K.G. Medical University, Lucknow-226003

More information

Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines)

Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines) Cardiovascular Health Nova Scotia Guideline Update Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines) Authors: Dr. M. Love, Kathy Harrigan Reviewers:

More information

TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY. Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU

TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY. Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU Objectives: 1. To discuss epidemiology and presentation

More information

Integrated Health Care Models and Practices

Integrated Health Care Models and Practices Integrated Health Care Models and Practices The Greater Houston Behav io r al Health Affordable Care Act Initiative S e c o n d C o m m u n i t y E d u c a t i o n E v e n t I n t e g r a t e d H e a l

More information

Management of Bipolar Disorder in Adults

Management of Bipolar Disorder in Adults QUICK REFERENCE F HEALTHCARE PROVIDERS Management of Bipolar Disorder in Adults Ministry of Health Malaysia Malaysian Psychiatric Association Academy of Medicine Malaysia KEY MESSAGES 1. Management of

More information

B.Sahasranaman,MD Medical Director Henderson Behavioral Health

B.Sahasranaman,MD Medical Director Henderson Behavioral Health B.Sahasranaman,MD Medical Director Henderson Behavioral Health No conflicts of interest No disclosures Florida Medicaid Drug Therapy Management Program for Behavioral Health administered by FMHI at USF

More information

Blood Pressure Weight BMI. Numbers KNOW YOUR LDL/HDL. Triglycerides. holesterol

Blood Pressure Weight BMI. Numbers KNOW YOUR LDL/HDL. Triglycerides. holesterol Blood Pressure Weight BMI Blood Sugar KNOW YOUR holesterol LDLHDL Numbers Triglycerides Your health truly is the most important thing in your life. Knowing your medical history and getting annual checkups

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

Summary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole)

Summary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole) EMA/303592/2015 Summary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole) This is a summary of the risk management plan (RMP) for Aripiprazole Pharmathen, which details the measures

More information

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections.

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections. National Diabetes Statistics What is diabetes? Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.

More information

Ohio Medicaid Health Homes. The Future for Providers and Patients

Ohio Medicaid Health Homes. The Future for Providers and Patients Ohio Medicaid Health Homes The Future for Providers and Patients Understand Prepare Provide 2012 Annual Conference on Aging Ohio Association of Area Agencies on Aging Making History Medical Reintegration

More information

YOUR GUIDE TO. Lowering The Risk of Heart Attack and Stroke

YOUR GUIDE TO. Lowering The Risk of Heart Attack and Stroke YOUR GUIDE TO Lowering The Risk of Heart Attack and Stroke The Mercy Health Heart Institute team is focused on helping you keep your heart healthy. As part of this effort, it s important for you to know

More information

Finding weight loss strategies that work in primary care

Finding weight loss strategies that work in primary care Finding weight loss strategies that work in primary care Article: Wilson C. Obesity: Finding weight loss strategies that work in primary care. Nat Rev Endocrinol. 2013;9(3):126. Review: In this Research

More information

Baskets of Care Diabetes Subcommittee

Baskets of Care Diabetes Subcommittee Baskets of Care Diabetes Subcommittee Disclaimer: This background information is not intended to be a comprehensive scientific discussion of the topic, but rather an attempt to provide a baseline level

More information

An Overview and Guide to Healthy Living with Type 2 Diabetes

An Overview and Guide to Healthy Living with Type 2 Diabetes MEETING YOUR GOALS An Overview and Guide to Healthy Living with Type 2 Diabetes MEETING YOUR GOALS This brochure was designed to help you understand the health goals to live a healthy lifestyle with type

More information

Prediabetes: A Woman s Perspective

Prediabetes: A Woman s Perspective Prediabetes: A Woman s Perspective AMERICAN COLLEGE OF ENDOCRINOLOGY CONSENSUS STATEMENT ON THE DIAGNOSIS AND MANAGEMENT OF PRE-DIABETES IN THE CONTINUUM OF HYPERGLYCEMIA Joanne Kaiser-Smith, D.O., FACOI,

More information

Managing Care for Adults With Long-term Medical Illnesses. A Review of the Research

Managing Care for Adults With Long-term Medical Illnesses. A Review of the Research Managing Care for Adults With Long-term Medical Illnesses A Review of the Research Is This Information Right for Me? If you meet all of the following, this information is for you: You or someone you care

More information

NAVIGATE Psychopharmacological Treatment Manual

NAVIGATE Psychopharmacological Treatment Manual NAVIGATE Psychopharmacological Treatment Manual Developed by The NAVIGATE Psychopharmacological Treatment Committee. The Committee is chaired by Delbert G. Robinson, M.D. Christoph U. Correll, M.D., Ben

More information

These guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes.

These guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes. This is a new guideline. These guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes. It incorporates NICE clinical

More information

Conjoint Professor Brian Draper

Conjoint Professor Brian Draper Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course

More information

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering

More information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and obesity History: A 13-year-old girl is seen for a routine clinic follow-up visit. She has been previously healthy, but her growth curve shows increasing body mass index (BMI) percentiles

More information

Student Project PRACTICE-BASED RESEARCH. Key words: antidepressant, antipsychotic, assertive community treatment, medication management, monitoring

Student Project PRACTICE-BASED RESEARCH. Key words: antidepressant, antipsychotic, assertive community treatment, medication management, monitoring Development of a Medication Monitoring System for an Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) Team Sarah C. Watkins*, PharmD Candidate 1 ; Bruce R. Winchester*, PharmD

More information

Who typically has Metabolic Syndrome? According to the American Heart Association, three groups of people often have metabolic syndrome:

Who typically has Metabolic Syndrome? According to the American Heart Association, three groups of people often have metabolic syndrome: Metabolic Syndrome By Seth Bilazarian, MD, FACC, FSCAI, RPVI Clinical and Intervential Cardiologist What is the Metabolic Syndrome? The Metabolic Syndrome is a collection of five problems that greatly

More information

CLINICAL PRACTICE GUIDELINE

CLINICAL PRACTICE GUIDELINE CLINICAL PRACTICE GUIDELINE Procedure: Diabetes Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014 PURPOSE:

More information

Evaluations. Viewer Call-In. www.t2b2.org. Phone: 800-452-0662 Fax: 518-426-0696. Geriatric Mental Health. Thanks to our Sponsors: Guest Speaker

Evaluations. Viewer Call-In. www.t2b2.org. Phone: 800-452-0662 Fax: 518-426-0696. Geriatric Mental Health. Thanks to our Sponsors: Guest Speaker Geriatric Mental Health June 1, 7 Guest Speaker Michael B. Friedman, LMSW Chairperson Geriatric Mental Health Alliance of New York Thanks to our Sponsors: School of Public Health, University at Albany

More information

BIPOLAR DISORDER IN PRIMARY CARE

BIPOLAR DISORDER IN PRIMARY CARE E-Resource January, 2014 BIPOLAR DISORDER IN PRIMARY CARE Mood Disorder Questionnaire Common Comorbidities Evaluation of Patients with BPD Management of BPD in Primary Care Patient resource Patients with

More information

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 1 Nutrition Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 2 Type 2 Diabetes: A Growing Challenge in the Healthcare Setting Introduction and background of type 2 diabetes:

More information

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include: Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic

More information

HealthCare Partners of Nevada. Heart Failure

HealthCare Partners of Nevada. Heart Failure HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with

More information

New Medicare Preventive

New Medicare Preventive New Medicare Preventive Services Screening Tests You Can Perform in the Office Charles B. Root, PhD Medicare is finally getting serious about preventive services. Until now, the limited preventive testing

More information

PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS. Juanaelena Garcia, MD Psychiatry Director Institute for Family Health

PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS. Juanaelena Garcia, MD Psychiatry Director Institute for Family Health PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS Juanaelena Garcia, MD Psychiatry Director Institute for Family Health Learning Objectives Learn basics about the various types of medications that

More information

Insulin Resistance and PCOS: A not uncommon reproductive disorder

Insulin Resistance and PCOS: A not uncommon reproductive disorder Insulin Resistance and PCOS: A not uncommon reproductive disorder Joyce L. Ross, MSN, CRNP, CS, FNLA, FPCNA Diplomate Accrediation Council for Clinical Lipidology President Preventive Cardiovascular Nurses

More information

Bipolar Disorder and Substance Abuse Joseph Goldberg, MD

Bipolar Disorder and Substance Abuse Joseph Goldberg, MD Diabetes and Depression in Older Adults: A Telehealth Intervention Julie E. Malphurs, PhD Asst. Professor of Psychiatry and Behavioral Science Miller School of Medicine, University of Miami Research Coordinator,

More information

CQMs. Clinical Quality Measures 101

CQMs. Clinical Quality Measures 101 CQMs Clinical Quality Measures 101 BASICS AND GOALS In the past 10 years, clinical quality measures (CQMs) have become an integral component in the Centers for Medicare & Medicaid Services (CMS) drive

More information

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?

More information

Major Depressive Disorder:

Major Depressive Disorder: Major Depressive Disorder: An Actuarial Commercial Claim Data Analysis July 2013 Prepared by: Milliman, Inc. NY Kate Fitch RN, MEd Kosuke Iwasaki FIAJ, MAAA, MBA This report was commissioned by Takeda

More information

Antipsychotic medications are an important

Antipsychotic medications are an important Reviews/Commentaries/Position C O N S E N S U S S T A T E M E N T Statements Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes AMERICAN DIABETES ASSOCIATION AMERICAN PSYCHIATRIC

More information

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Bipolar Disorder, Schizophrenia and Schizoaffective Disorder Symptoms and Prevalence of Bipolar Disorder Bipolar disorder, formerly known

More information

Diabetes and mental illness have long

Diabetes and mental illness have long IDENTIFYING AND MANAGING THE PSYCHIATRIC PATIENT AT RISK FOR TYPE 2 DIABETES * Virginia Valentine, CNS, BC-ADM, CDE ABSTRACT The prevalence of diabetes in the mentally ill may be up to 3 times that in

More information

Behavioral Health Services 14.0

Behavioral Health Services 14.0 Behavioral Health Services 14.0 Kaiser Permanente s Behavioral Health Services operates within the multi-specialty Mid- Atlantic Permanente Medical Group (MAPMG). It is a regional service committed to

More information

Antipsychotic drugs are the cornerstone of treatment

Antipsychotic drugs are the cornerstone of treatment Article Effectiveness of Olanzapine, Quetiapine, Risperidone, and Ziprasidone in Patients With Chronic Schizophrenia Following Discontinuation of a Previous Atypical Antipsychotic T. Scott Stroup, M.D.,

More information

DIABETIC AWARENESS CAMP

DIABETIC AWARENESS CAMP DIABETIC AWARENESS CAMP We have organized Diabetic awareness camp on world Diabetic Day on dt.14/11/11 at village Samser padar with the following objectives: 1. Awareness raising on diabetic 2. Frequently

More information

Is Insulin Effecting Your Weight Loss and Your Health?

Is Insulin Effecting Your Weight Loss and Your Health? Is Insulin Effecting Your Weight Loss and Your Health? Teressa Alexander, M.D., FACOG Women s Healthcare Associates www.rushcopley.com/whca 630-978-6886 Obesity is Epidemic in the US 2/3rds of U.S. adults

More information

PSYCHIATRY FOR PCPs BIPOLAR DISORDER

PSYCHIATRY FOR PCPs BIPOLAR DISORDER PSYCHIATRY FOR PCPs BIPOLAR DISORDER David A Harrison, MD, PhD Assistant Professor Dept of Psychiatry & Behavioral Sciences University of Washington School of Medicine Mood Disorders: Diagnosis & Treatment

More information

Wasteful spending in the U.S. health care. Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs

Wasteful spending in the U.S. health care. Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs by Christopher J. Mathews Wasteful spending in the U.S. health care system costs an estimated $750 billion to $1.2 trillion

More information

Diagnosis, classification and prevention of diabetes

Diagnosis, classification and prevention of diabetes Diagnosis, classification and prevention of diabetes Section 1 1 of 4 Curriculum Module II 1 Diagnosis, classification and presentation of diabetes Slide 2 of 48 Polyurea Definition of diabetes Slide 3

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

Shared Care Protocol for Atypical Antipsychotics

Shared Care Protocol for Atypical Antipsychotics Shared Care Protocol for Atypical Antipsychotics Version Number: 2 Name of originator/author: Chief Pharmacist, 07813 783165 (with thanks to GMW) Name of responsible committee: Clinical Governance Committee

More information

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Judith Long, MD,RWJCS Perelman School of Medicine Philadelphia Veteran Affairs Medical Center Background Objective Overview Methods

More information

Best Principles for Integration of Child Psychiatry into the Pediatric Health Home

Best Principles for Integration of Child Psychiatry into the Pediatric Health Home Best Principles for Integration of Child Psychiatry into the Pediatric Health Home Approved by AACAP Council June 2012 These guidelines were developed by: Richard Martini, M.D., co-chair, Committee on

More information

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers SUPPLEMENT 1: (Supplementary Material for online publication) Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers About this

More information

Clinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper

Clinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper Clinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper As the need grows for more practitioners of primary care, it is important to recognize the Clinical Nurse Specialist

More information

New-Onset Diabetes after Transplantation

New-Onset Diabetes after Transplantation New-Onset Diabetes after Transplantation Dr Mahmoud Darouich Ministry of Health - Damascus The tenth conference of syrian society of nephrology and transplantation Mashta-Alhelou 6-8/11/2008 Cause of Death

More information

South African Cholesterol Guidelines Compared

South African Cholesterol Guidelines Compared South African Cholesterol Guidelines Compared Jacqueline van Schoor, Amayeza Info Centre While infectious diseases are currently the leading cause of death in South Africa, cardiovascular disease (CVD)

More information

HEALTHY LIVING WITH CHRONIC CONDITIONS PHYSICIAN TOOLKIT

HEALTHY LIVING WITH CHRONIC CONDITIONS PHYSICIAN TOOLKIT HEALTHY LIVING WITH CHRONIC CONDITIONS PHYSICIAN TOOLKIT HEALTHY LIVING WITH CHRONIC CONDITIONS SHARED DECISION MAKING HELPING MY PATIENTS BECOME INVOLVED Shared Decision Making (SDM) has been shown to

More information