**8. Conclusion**

Despite the availability of published clinical guidelines, patients with mental illness receiving medications remain vulnerable to the cardio-metabolic complications of these drugs. Implementation of a coordinated metabolic monitoring and management program for patient with mental illness will require a review of current practice and the introduction of new procedures, both of which will require time and effort on the part of the health care community.

Involvement of patient with mental illness in their treatment program will require the provision of information about their condition and medication and the development of approaches that empower, encourage, and support patients in their decisions on treatment and well-being.

The evaluation of new therapies should include detailed assessments of physical health and future risk estimates in addition to standard psychiatric outcomes. Psychiatrists have to arrange the appropriate examination and investigation of patients at risk of developing

In the general population there are many studies evaluating the impact of lipid lowering in primary and secondary prevention of coronary heart disease and stroke, but there are some concerns about its value in primary prevention, especially in vulnerable population (Vrecer

Whether a low or lowered serum cholesterol level is associated with harm has been the subject of debate for a long time; ever since the unexpected finding of an increased risk of noncardiovascular mortality in early trials of lipid-lowering therapy. Subsequent research has generated conflicting evidence regarding the relation between cholesterol and violent behavior, mental illness , with positive studies imputing alterations in central serotoninergic activity as a potential underlying mechanism. A case-control study studied a cohort of 94441 individuals, 458 had newly diagnosed depression and 105 had a recorded diagnosis of suicide risk. Compared with matched control subjects, and even after adjustment for potential confounders, neither dyslipidemia nor its treatment was associated with an increase risk of depression. Similarly, no association was found between treatment and

A 3-month study demonstrated that statins prescribed to patients with schizophrenia and severe dyslipidemia whilst taking antipsychotic medication led to a significant improvement in lipid profiles (Hanssens et, 2007). An earlier study with rosuvastatin proved effective in managing dyslipidemia in schizophrenic patients on antipsychotics. This study showed improvement in lipid profiles but not benefits in terms of high-density

This last study supports the view that statins can be safely used in the short term to control abnormal lipids levels. However, there are no long-term data on its impact on either relapse

The presence of metabolic syndrome is an indication for more aggressive lipid-lowering measures. Medications that raise HDL, nicotinic acid or fibrates, may be particularly beneficial in patients with metabolic syndrome, but they have not been as widely studied as

The preferred initial management is still very much a lifestyle modification approach

Despite the availability of published clinical guidelines, patients with mental illness receiving medications remain vulnerable to the cardio-metabolic complications of these drugs. Implementation of a coordinated metabolic monitoring and management program for patient with mental illness will require a review of current practice and the introduction of new procedures, both of which will require time and effort on the part of the health care

Involvement of patient with mental illness in their treatment program will require the provision of information about their condition and medication and the development of approaches that empower, encourage, and support patients in their decisions on treatment

The evaluation of new therapies should include detailed assessments of physical health and future risk estimates in addition to standard psychiatric outcomes. Psychiatrists have to arrange the appropriate examination and investigation of patients at risk of developing

lipoprotein, waist measurement, BMI or glucose homeostasis (De Hert et al, 2006).

or all-cause mortality, and again this is a priority for research.

medications that lower LDL-cholesterol in patients with mental illness.

**7.4 Medication** 

et al, 2003).

suicide risk. (Yang, 2003).

including exercise and diet.

**8. Conclusion** 

community.

and well-being.

significant physical morbidity, working very closely with general practitioners and with other specialists when appropriate. We have to weight up the risk of metabolic disturbance and its potential impact on future cardiovascular risk when selecting an antipsychotic drug. We have to take a careful medical history and be prepared to monitor weight and other metabolic risk, such as glucose and lipid profile. The lipid area is significantly understudied in patients taking antipsychotic medications. Lipids may be more important than diabetes because dyslipidemia appears to occur at a higher prevalence in this patient population. Lipid levels are a significant problem because physicians are seeing hypertriglyceridemia. Knowing what we know about what causes and contributes to cardiovascular disease, we are obliged to play detective and figure out why psychiatric patients are dying sooner and more often of cardiovascular disease than the general population.

The big challenge for all is to ensure that the physical health of patients with mental illness is given the priority it deserves, helping them to face their future with the lowest possible morbidity and mortality odds stacked against them.
