serious mental illness

...

if you are su- suffering from severe mental illness, you are not gonna act in a way that's rational to most people.

I, this is one of the biggest gripes that I have with our conversations around mental health, is that we have such productive conversations around anxiety and depression and all of these, um, quote, unquote, "palatable" mental health disorders that actually still are stigmatized-

Yeah

The main reason, though, that we wanted to talk to you guys today about oral health and mental health is that patients often...

when they see us as psychiatrists, they may not have a number of other contacts in their life, particularly patients who suffer severe mental illness.

Their psychiatrist, their therapist, their GP may be the only people that they see on a regular basis throughout most of their life.

And what that means is that we're an incredible point of contact for them.

But what we have most information about is how people with diabetes mental illness have particularly poor oral health, and that stems from a number of factors.

Partly that's due to issues such as lifestyle.

So we know people, particularly people with severe mental illness, tend to smoke, tend to use substances, and that in their own right can aggravate oral health problems.

They also often have limited financial means.

Otherwise, GI complaints were the most common problem, not surprisingly, including constipation, which was numerically a bit higher in the semaglutide group, but not limited to the treatment group.

So why is this trial important? It shows that GLP-1 agonists work in our patients with serious mental illness, something that was not a given.

There was the concern that the antipsychotic would physiologically counteract the efficacy of added GLP-1 agonists.

This turned out to be wrong.

For a definite answer, if we can improve mortality in our patients by using these drugs, we will need long-term trials with hard outcomes, including myocardial infarction, stroke, or, and sorry to say, death.

Bottom line, in the SASS trial, the GLP-1 agonist semaglutide meaningfully reduced weight- and reversed beginning metabolic abnormalities in patients with schizophrenia who were treated with olanzapine or clozapine for less than five years.

This is an exciting time for the medically inclined psychiatrist, and I'm one of them, who is trying to manage patients with serious mental illness like schizophrenia holistically, paying attention to symptoms and medical morbidity and mortality.

Up until now, we really only had metformin or topiramate to manage antipsychotic-induced weight gain, and neither of them worked that well.

I'm your host and web editor, Dr. John Torres.

Today, we're thrilled to be discussing a new paper just out in JAMA Psychiatry, GLP-1 Receptor Agonists, Mortality and Cardiovascular Outcomes in Serious Mental Illness.

We're about to speak with Professor Roger McIntyre, MD, the Department of Psychiatry and Department of Pharmacology and Toxicology at University of Toronto, as well as the Brain and Cognition Discovery Foundation in Toronto, Ontario, Canada.

People with serious mental illness die on average 10 to 25 years earlier than the general population.

Cardiovascular disease is the single largest driver of that gap, but for decades it has stubbornly persisted.

What if a new class of medications developed for diabetes and obesity, of course, the GLP-1 agonists are always in the news and even covered on prior podcasts here, could actually help? To find out, we're about to speak with the corresponding author of a new study just published in JAMA Psychiatry that examines outcomes of more than 1.5 million people.

So thank you for joining us, Dr. McIntyre.

And to jump in, let's set the stage.

Correct.

Now, you mentioned earlier, um, serious mental illness.

What is considered to be a serious mental illness?

Well, serious mental illnesses affect a small, um, portion of the, the population, a smaller portion, uh, maybe four percent.

So people who have schizophrenia, um, have a serious mental illness.

Uh, people who have bipolar I, which is, um, manic depressive illness, um, that is a serious mental illness.

Schizoaffective disorder is also a serious mental illness.

So while many people can have symptoms of mental illness and can benefit from treatment, either psychotherapy or medication or some kind of combination, there are some that are just really, really profound.

She's about halfway through them.

She has a daughter with schizophrenia, and she sent me an email and said y- "Your podcast, for me, is an SMI master's degree." And I just thought that was so perfect, I wanted to share it.

I think that's actually a, and Nicole is nodding her head, if any of you can't-

[laughs]

... are you listening instead of looking, we're an SMI master's degree, so I love that.

I love that too, and I just wanna say we take no credit.

We don't have master's degrees or MDs, so d- you know, uh, I, I think we may be an emotional master's course and just give our-

There are apps that can track literally the tenor, the speed, the sound of someone's voice.