BAP Guidelines on the Management of Weight Gain, Metabolic Disturbances and Cardiovascular Risk Associated With Psychosis and Antipsychotic Drug Treatment

Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users’ negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance (‘pre-diabetes’), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines. These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.

Visualising Spaces: The Illustrated Map as a Mode of Communicating Fact, Fiction and Feeling

Communicating thoughts, facts and narratives through visual devices such as allegory or symbolism was fundamental to early map making and this remains the case with contemporary illustration. Drawing was employed then as a way of describing historic narratives (fact and folklore) through the convenience of a drawn symbol or character. The map creators were visionaries, depicting known discoveries and anticipating what existed beyond the agreed boundaries. As we now have photographic and virtual reality maps at our disposal, how can illustration develop the language of what a map is and can be? How can we break the rules of map design and yet still communicate the idea of a sense of place with the aim to inform, excite and/or educate the ‘traveller’? As Illustrators we need to question the purpose of creating a ‘map’: what do we want to communicate and is representational image making the only way to present information of a location? Is creating a more personal interpretation a form of cartouche, reminiscent of elements within the Hereford Mappa Mundi and maps of Blaeu, and can this improve/hinder the communicative aspect of the map? Looking at a variety of historical and contemporary illustrated maps and artists (such as Grayson Perry), who track their journeys through drawing, both conventional journeys and emotional, I will aim to prove that the illustrated map is not mere decoration but is a visual language providing an allegorical response to tangible places and personal feelings.