Impact of medical comorbidities on patients with severe mental illness

Abstract

Patients with schizophrenia and bipolar disorder carry a heavy burden of medical comorbidities. Patients with schizophrenia or bipolar disorder have a life expectancy that is 15 years less than that of the general population. This increased mortality is partly associated with factors inherent to the patients' psychopathology. For example, the risk of suicide is about 20 times higher than that of the general population. However, despite increased psychiatric mortality, cardiovascular disease is the primary cause of death in patients with schizophrenia. While some of this morbidity is the acknowledged result of long-term antipsychotic medication, not all can be explained by pharmacotherapy-for example, patient lifestyle choices may account for at least part of this elevated risk. Smoking, for example, is much more common among patients with schizophrenia than the general population. However, psychotic patients often have undetected general health problems despite a higher than average physician consultation rate, suggesting that there is inadequate monitoring and treatment of the physical health of individuals with mental health problems. This may reflect the fact that mental healthcare is separated from physical healthcare in many countries and access to primary healthcare is often limited for individuals with mental illness.