US psychiatrists have greater perception of metabolic syndrome in bipolar disorder

Survey results have revealed that US psychiatrists are leading the way with regards to the perception and management of the metabolic syndrome among patients with bipolar disorder compared with their European counterparts. It is hoped that raising awareness of may change practice habits of psychiatrists’ clinical management of patients with bipolar disorder. How the metabolic syndrome impacts on the management and treatment of psychiatric disorders is currently an issue of great import, yet little is know about the consideration given to it when psychiatric treatment decisions are made. Lecrubier et al. sought to determine how the growing recognition of metabolic safety is affecting clinical decision-making in bipolar disorder. Both environmental and genetic factors contribute to the development of the metabolic syndrome in both patients with bipolar disorder and the general population; however, for patients with bipolar disorder it may be exacerbated by pharmacotherapy. Tricyclics antidepressants and monoamine oxidase inhibitors are frequently associated with weight gain as are typical and atypical antipsychotics. In the current article, Lecrubier et al. report on the results of surveys of practicing US and European psychiatrists (from the UK, France, Italy, Germany and Spain) to determine how the increasing recognition of metabolic safety is being reflected in clinical decision-making in bipolar disorder. A brief, self-administered online survey that was mailed to a randomly selected sample of 10,000 psychiatrists in the US, and in the European Union (EU), potential respondent psychiatrists were recruited from an existing European physician panel in 2005 and 2006. All respondents underwent the same screening process, and were offered an honorarium for completion of the survey. A total of 500 US and 718 European psychiatrists completed the survey. The results revealed that the majority of both US and EU psychiatrists considered metabolic health an important issue in the treatment of patients with bipolar disorder. However, Lecrubier et al. found that US psychiatrists reported significantly more overweight or obese patients (48% versus 40%; p<0.05), but a similar relative number of patients met the NCEP (National Cholesterol Education Program) criteria for metabolic syndrome in the US and EU (27% versus 25%). They also found that changing therapy in response to worsening metabolic health occurred more readily among US psychiatrists than their EU counterparts. This was reflected by 40% of EU respondents indicating that they “rarely” or “never” stopped or switched therapies because of metabolic health concerns compared to 15% of US respondents. In contrast, 25% of US respondents versus 8% of EU respondents reported having stopped or switched therapies “often” or “very often” due to metabolic health concerns. Interestingly, there was considerable variability among the EU countries with regards to the level of familiarity of the metabolic syndrome. German psychiatrists demonstrated the highest level of familiarity and French the lowest. The authors suggested that this may be related to higher rates of overweight and obesity in Germany than in France . “Among the individual EU countries, responses of German psychiatrists were generally most similar to those of US psychiatrists,” they affirmed. The authors stated that differences exist in how US and EU psychiatrists consider and respond to metabolic risks among patients with bipolar disorder, with data suggesting that US psychiatrists are more likely than their EU counterparts to view the metabolic syndrome as a clinically significant threat to the health of their patients. However, variability exists between EU countries. However the authors did note that US psychiatrists may be more aware of metabolic issues due to the increasing prevalence of the syndrome among the US population making exposure to the syndrome in their practices more likely. “Medical comorbidity in bipolar disorder has been associated with a more severe disease course, emphasising the need for psychiatrists to be alert to the symptoms of metabolic disorders in this patient population,” they warned. Reference Lecrubier, Y. Bauer, M. et al. 2008, ‘Awareness of the metabolic syndrome in patients with bipolar disorder: A comparison of US and European psychiatrists’ International Journal of Psychiatry in Clinical Practice 12: 187—195....