April 15, 2019
By Barbara Iruretagoyena, Alfonso González – Valderrama, Carmen Castañeda and Cristián Mena
We asked Cristián Mena and colleagues from the Early Intervention Psychosis Program in Chile to provide their research insights into the physical health of young people with psychosis in Latin America.
About the program
This Chilean mental health program provides inpatient and outpatient mental health services at the Dr J. Horwitz Psychiatric Institute, as part of the Chilean National Public System, to young people who have experienced a first episode of psychosis (FEP). The program works alongside young people and their families to achieve the best possible psychological, physical and social wellbeing outcomes. Using a multidisciplinary approach, the program is founded on an optimistic and anti-stigma viewpoint that is committed to providing high-quality healthcare to young people. Over the last few years, the program has focused on the physical health of young people with FEP, collaborating with the pioneer in this area – the iphYs networking group – to promote physical wellbeing as an essential element of early intervention in mental health. For more information, visit the website www.proitp.cl
Physical health in people with psychosis and schizophrenia is an issue that is recognised worldwide. We currently know that people with schizophrenia have lower life expectancy compared to the general population, which is mostly due to the increased risk of developing cardiovascular diseases.An example of this is the higher prevalence of metabolic syndrome in people with schizophrenia, even after the first months of antipsychotic treatment.
Cardiometabolic issues are documented in the Latin American population, with studies suggesting a higher risk for abdominal obesity and metabolic syndrome (INTERHEART, INTERSTROKE). Despite this, we have limited information about what is happening with cardiometabolic issues in young people with psychosis in our region.
With that in mind, we decided to explore the prevalence of metabolic changes and metabolic syndrome in a Latin-American group of young people with early psychosis compared to the general Chilean population. We observed that this group had a very high prevalence of metabolic syndrome (44.7%) during the first five years after their first episode of psychosis. This prevalence is higher than previously reported for schizophrenia patients in other countries, even though our group was composed of young people with early psychosis. The risk for metabolic syndrome in the group of young people with psychosis was 5.28 times higher than their age peers in the general population, higher than the risk reported in a previous meta-analysis.
With more than 650 million people, Latin America is an important region of interest for our understanding of psychosis and its consequences. Our results highlight the need for early interventions in physical health in Latino young people with psychosis. Population-level interventions, such as general promotion of healthy lifestyles in the community, are helpful but not enough. Specific and innovative interventions must be developed by service users, their families, clinicians and policymakers to give better answers to this critical part of early intervention in psychosis programs. Further research on the physical health of people with psychosis outside of Europe, North America and Australia is also urgently needed.