Metabolic syndrome and response to treatment in psychiatric patients on an Assertive Community Treatment (ACT) team

ABSTRACT: Patients with severe and persistent mental illness (SPMI) have an increased incidence of metabolic syndrome, which is associated with increased risk of cardiovascular disease, type 2 diabetes and premature death. The National Cholesterol Education Program has proposed that 3 or more of the following clinical criteria define metabolic syndrome: abdominal obesity, elevated triglycerides, decreased HDL, elevated BP, and elevated fasting glucose. SPMI patients are at increased risk for metabolic syndrome both because of their illnesses and treatment with atypical antipsychotic medications. Metformin, an oral anti-diabetes drug, has been shown to effectively treat metabolic syndrome in SPMI patients, as have behavioral interventions designed to affect diet, exercise, and other modifiable lifestyle variables. Assertive Community Treatment (ACT) is a SAMSHA evidence-based practice for treating SPMI patients who require more than standard care. ACT patients are at high risk for developing metabolic syndrome, but are infrequently diagnosed or treated. Few studies examine prevalence rates of metabolic syndrome in ACT patients, or its treatment as administered by the ACT team. This study examines rates of metabolic syndrome in 66 patients treated by the Visiting Nurse Service of New York's Manhatttan ACT team, and the efficacy of treatment administered by the ACT team with metformin and/or behavioral intervention.