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.

Air Temperature Distribution and Energy-balance Modelling of a Debris-covered Glacier

Near-surface air temperature is an important determinant of the surface energy balance of glaciers and is often represented by a constant linear temperature gradients (TGs) in models. Spatiotemporal variability in 2 m air temperature was measured across the debris-covered Miage Glacier, Italy, over an 89 d period during the 2014 ablation season using a network of 19 stations. Air temperature was found to be strongly dependent upon elevation for most stations, even under varying meteorological conditions and at different times of day, and its spatial variability was well explained by a locally derived mean linear TG (MG–TG) of −0.0088°C m−1. However, local temperature depressions occurred over areas of very thin or patchy debris cover. The MG–TG, together with other air TGs, extrapolated from both on- and off-glacier sites, were applied in a distributed energy-balance model. Compared with piecewise air temperature extrapolation from all on-glacier stations, modelled ablation, using the MG–TG, increased by <1%, increasing to >4% using the environmental ‘lapse rate’. Ice melt under thick debris was relatively insensitive to air temperature, while the effects of different temperature extrapolation methods were strongest at high elevation sites of thin and patchy debris cover.