WHEN DOES THE TROUBLE START? OBESITY, DIABETES RISKS AND METABOLIC DISTURBANCES IN YOUNG PEOPLE WITH PSYCHOSIS

People with psychotic disorders have higher mortality rates compared to the general population. Most deaths are due to cardiovascular (CV) disease, reflecting high rates of CV risk factors such as obesity and diabetes. Treatment with antipsychotic drugs is associated with weight gain in clinical trials. However, there is little information about how these drugs affect children and young people, and how early in the course of treatment the elevation in CV risk factors begins. This information is essential in understanding the costs and benefits of these treatments in young people, and establishing preventive and early intervention services to address physical health comorbidities. This symposium reports both prospective and naturalistic data from children and adolescents treated with antipsychotic drugs. These studies demonstrate that adverse effects on cardiometabolic measures, notably BMI and insulin resistance, become apparent very soon after treatment is initiated. Further, children and adolescents appear to be even more sensitive to these effects than adults. Population-wide studies are also informative. Danish data showing that young people exposed to antipsychotics have a higher risk of diabetes, compared with young people who had a psychiatric diagnosis but were not exposed to antipsychotic drugs, will be presented. In addition, an Australian comparison between a large, nationally representative sample of people with psychosis and a general population sample shows that higher rates of obesity and other cardiometabolic abnormalities are already evident in people with psychosis by the age of 25 years. Young people living with psychosis are already disadvantaged by the demands of living with mental illness, stigma, and social factors such as unemployment and low income. The addition of obesity, diabetes and other comorbidities adds a further burden. The data presented highlights the need for careful selection of antipsychotic drugs, regular monitoring of physical health and early intervention when weight gain, glucose dysregulation, or other cardiometabolic abnormalities are detected

Psychotische Störungen im DSM-5

This article provides an overview of the main changes in the chapter "Schizophrenia Spectrum and Other Psychotic Disorders" from DSM-IV-TR to DSM-5, which, once again, does not make allowance for potential characteristics of children and adolescents. Changes in the main text include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one having to be a positive symptom) in the definition of Schizophrenia and the allowance for bizarre contents in Delusional Disorders. Further introduced are the diagnosis of a delusional obsessive-compulsive/body dysmorphic disorder exclusively as Obsessive-Compulsive Disorder, the specification of affective episodes in Schizoaffective Disorder, and the formulation of a distinct subchapter "Catatonia" for the assessment of catatonic features in the context of several disorders. In Section III (Emerging Measures and Models) there is a recommendation for a dimensional description of psychoses. A likely source of confusion lies in the double introduction of an "Attenuated Psychosis Syndrome." On the one hand, a vague description is provided among "Other Specified Schizophrenia Spectrum and Other Psychotic Disorders" in the main text; on the other hand, there is a precise definition in Section III as a "Condition for Further Study." There is some cause to worry that this vague introduction of the attenuated psychosis syndrome in the main text might indeed open the floodgates to an overdiagnosis of subthreshold psychotic symptoms and their early pharmacological treatment.Es wird eine Übersicht über die hauptsächlichen Änderungen des Kapitels «Schizophrenie-Spektrum und andere psychotische Störungen» von DSM-IV-TR zu DSM-5 gegeben, in dem erneut etwaigen Besonderheiten von Kindern und Jugendlichen nicht Rechnung getragen wird. Diese umfassen im Haupttext den Verzicht auf die klassischen Subtypen der Schizophrenie sowie die Aufgabe des besonderen Stellenwerts der Schneider’schen Erstrangsymptome und damit verbunden die Forderung von mindestens zwei Leitsymptomen (obligatorisch mindestens ein Positivsymptom) bei der Schizophrenie sowie Zulassung bizarrer Wahninhalte auch bei Wahnhaften Störungen. Neu sind zudem die Kodierung wahnhafter Zwangs-/Körperdysmorpher Störungen ausschließlich unter den Zwangsstörungen, die Präzisierung affektiver Episoden bei der Schizoaffektiven Störung und die Einführung einer eigenen Sektion «Katatonie» zur Beschreibung katatoner Symptome innerhalb verschiedendster Krankheitsbilder. In der Sektion III (Aufkommende Messmittel und Modelle) findet sich zudem der Vorschlag einer dimensionalen Beschreibung von Psychosen. Verwirrend ist die doppelte Einführung eines «Attenuated Psychosis» Syndromes: zum einen vage umschrieben unter die «Anderen spezifizierten Schizophrenie-Spektrum und anderen psychotischen Störungen» im Haupttext, zum anderen klar definiert unter die «Bedingungen mit weiterem Forschungsbedarf» der Sektion III. Mit dieser nicht spezifizierten Aufnahme des Attenuated Psychosis Syndromes in den Haupttext ist einer befürchteten Überdiagnostizierung subschwelliger psychotischer Symptome und deren frühzeitiger psychopharmakologischer Behandlung nun doch Tür und Tor geöffnet