Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
University Psychiatric Centre-KU Leuven, Kortenberg, Belgium.
Eur Psychiatry. 2021 Jan 8;64(1):e7. doi: 10.1192/j.eurpsy.2020.115.
Patients with schizophrenia spectrum disorders (SSD) have worse physical health and reduced life expectancy compared to the general population. In 2009, the European Psychiatric Association, the European Society of Cardiology and the European Association for the Study of Diabetes published a position paper aimed to improve cardiovascular and diabetes care in patients with severe mental illnesses. However, the initiative did not produce the expected results. Experts in SSD or in cardiovascular and metabolic diseases convened to identify main issues relevant to management of cardiometabolic risk factors in schizophrenia patients and to seek consensus through the Delphi method.
The steering committee identified four topics: 1) cardiometabolic risk factors in schizophrenia patients; 2) cardiometabolic risk factors related to antipsychotic treatment; 3) differences in antipsychotic cardiometabolic profiles; 4) management of cardiometabolic risk. Twelve key statements were included in a Delphi questionnaire delivered to a panel of expert European psychiatrists.
Consensus was reached for all statements with positive agreement higher than 85% in the first round. European psychiatrists agreed on: 1) high cardiometabolic risk in patients with SSD, 2) importance of correct risk management of cardiometabolic diseases, from lifestyle modification to treatment of risk factors, including the choice of antipsychotic drugs with a favourable cardiometabolic profile. The expert panel identified the psychiatrist as the central coordinating figure of management, possibly assisted by other specialists and general practitioners.
This study demonstrates high level of agreement among European psychiatrists regarding the importance of cardiovascular risk assessment and management in subjects with SSD.
与普通人群相比，精神分裂症谱系障碍（SSD）患者的身体健康状况较差，预期寿命缩短。2009 年，欧洲精神病学协会、欧洲心脏病学会和欧洲糖尿病研究协会发表了一份立场文件，旨在改善严重精神疾病患者的心血管和糖尿病护理。然而，该倡议并未产生预期的结果。SSD 或心血管和代谢疾病方面的专家聚集在一起，确定了与精神分裂症患者管理心脏代谢危险因素相关的主要问题，并通过德尔菲法寻求共识。
指导委员会确定了四个主题：1）精神分裂症患者的心脏代谢危险因素；2）与抗精神病药物治疗相关的心脏代谢危险因素；3）抗精神病药物心脏代谢特征的差异；4）心脏代谢风险的管理。12 项关键声明被纳入一份德尔菲问卷，分发给一组欧洲精神病学家专家小组。
在第一轮中，所有声明的积极同意率均高于 85%，达成了共识。欧洲精神病学家同意：1）SSD 患者存在高心脏代谢风险，2）正确管理心脏代谢疾病的重要性，包括从生活方式改变到治疗危险因素，包括选择具有良好心脏代谢特征的抗精神病药物。专家组确定精神科医生是管理的核心协调人，可能会得到其他专家和全科医生的协助。
这项研究表明，欧洲精神病学家高度一致认为，对 SSD 患者进行心血管风险评估和管理非常重要。
