1. Why the Lester Lab-in-the-Bag?
for People Experiencing Psychosis
Professor Paul French: Associate Director Greater Manchester Mental
Health NHS FT, Early Intervention in Psychosis lead NHSE North
Dr David Shiers: former GP North Staffordshire,
honorary reader in Early Psychosis, Manchester Univ
Cromwell House February 24th 2017 e:
Early Intervention in psychosis NSF mental health policy implementation RADICAL UPSTREAM YOUTH FOCUSED INTENSIVE COMMUNITY-BASED
NOW  MOST YP WITH P CAN ACCESS EIS IN ENGLAND  LESS CRISIS, MORE PROACTIVE
EBM INTERVENITIONS WHICH ARE AGE AND PPHASE SPECIFIC
DECREASING TURMOIL OF FEP UNDERSTANDABLE FOCUS
HOWEVER I  ATTENTION TO ANISSUE WHICH MAY GET OVERLOOKED –
IMPACT OF P ON DOWNSTREAM PHYSICAL HEALTH
25YRS LOSS OF EXPECTANCY – GREATER CONTRIBUTION TO THESE PREMATURE DEATHS FROM PHYSICAL EXPLANATIONS THAN FROM SUICIDE
MY HOPE IS YOU WILL TAKE AWAY
TO KEEP BODY IN MIOND NEXT TIME YOU SEE A YP WITH A DIAGNOSIS OF PSYCHOSIS IN YOUR SURGERY

2. Dame Professor Sue Bailey
2013
2016
The fact that people with severe mental illness die twenty years earlier than the rest of the population, the majority from preventable causes, is one of the biggest health scandals of our time, yet is very rarely talked about.
Dame Professor Sue Bailey

3. 12 kg 4 kg kg Months 3 kg First episode of psychosis RCTs
Figure 1. ANTIPSYCHOTIC-INDUCED WEIGHT GAIN IN CHRONIC AND FIRST-EPISODE PSYCHOTIC DISORDERS: A SYSTEMATIC CRITICAL REAPPRAISAL 20
Established Psychosis
RCTs
Established psychosis RCTs
3 kg 15
4 kg kg 10
12 kg 5
First episode of psychosis RCTs 12 24
Months 36 48
Published with permission from Dr Mario Alvarez-Jimenez.
Data from Alvarez-Jimenez et al; CNS Drugs, :

4. Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial CINP doi: /S
Fleischhacker WW, Siu CO, Bode R, Pappadopulos E, Karayal ON, Kahn RS, and the EUFEST study group
Overall baseline prevalence of metabolic syndrome was 6.0%, with similar rates observed in the antipsychotic-naive patients (5.7%) and in the other patients with only a brief prior exposure to antipsychotics (6.1%).

5. ...on a path to obesity, type 2 diabetes, cardiovascular disease and premature death
METABOLIC SYNDROME
Central obesity
Insulin resistance
Dyslipidemia
Hypertension +
SMOKING
Metabolic Syndrome is a clinical concept whose presence predicts higher rates of CVD and type 2 diabetes
The primary abnormality is an abnormal waist circumference This may drive the other abnormalities listed

6. Relative to gen population
CVD Risk
Factor
SCHIZOPHRENIA
BIPOLAR DISORDER
Rate
Relative to gen population
Smoker
50-80%
2-3x
54-68%
Obese
45-55% 2x
21-49%
1-2x
Physically inactive
70%
1.5-2x
Hypertension
19-58%
35-61%
Type 2 diabetes
10-15%
8-17%
1.5-3x
Lipid disturbances
25-69%
≤5x
23-38%
≤3x
Adapted from De Hert et al (2011) Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry, 10: 52-77
And Lindamer et a (2008) Assessment of physical activity in middle-aged and older adults with schizophrenia. Schizophr Res, 104: l

7. “The provision of good medical care tends to vary inversely with the need for it in the population served.”
Julian Tudor Hart Glyncorrwg 1971

8. www.rcpsych.ac.uk/quality/NAS/resources UK intervention framework
launch 2012, update 2014
Collaborative approach to
tackling CVD and T2 diabetes
risks in any service setting.
Supported by key Royal Colleges
Rethink Mental Illness, Faculty
of Public Health, Diabetes UK
Core of NHSE CQUINs 2014/19

9. Glucose and lipid disturbances
DON’T JUST SCREEN…
Smoking
Poor diet & inactivity
Glucose and lipid disturbances
Hypertension
Poor prescribing

10. 2013-15 DON’T SCREEN, INTERVENE JUST 2013: NICE guideline CG 155
Children and young people
experiencing psychosis and schizophrenia
2014: NICE guideline CG 178
Adults experiencing psychosis and
schizophrenia
2015: NICE Quality Standard 80
Mention iphYs development and NSW health support