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Physical health problems in schizophrenia and other serious mental illnesses

Published online by Cambridge University Press:  01 July 2007

Cherian Sebastian  and
M Dominic Beer
Cherian Sebastian*
Affiliation:
Staff Grade Psychiatrist Oxleas NHS Foundation Trust
M Dominic Beer
Affiliation:
Consultant Psychiatrist Oxleas NHS Foundation Trust and Honorary Senior Lecturer (Institute of Psychiatry, University of London)
*
Correspondence to: Dr M.D. Beer, The Bracton Centre, Oxleas NHS Foundation Trust, Bracton Lane, Dartford, Kent DA2 7AF, UK; Email: dominic.beer@oxleas.nhs.uk
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Abstract:

Background: Physical illnesses are more prevalent among patients with serious and enduring mental illnesses. This is mainly due to the association between mental and physical illnesses, complications of the mental illness itself and as a side effect of medication. Medical problems can be overlooked by psychiatrists due to several reasons. More research and audit of the existing services are necessary to establish the physical needs of patients with complex mental health problems.

Aim: To give an account of the causes of excessive mortality and physical morbidity among patients with serious mental health problems.

Method: Review of the worldwide literature.

Results: Physical problems are more common and the standardised mortality rate (SMR) is higher in psychiatric patients compared to the general population. The main causes are association between mental and physical illnesses, lifestyle including lack of physical activity, smoking and poor dietary habits, metabolic syndrome, diabetes mellitus and other cardiac risk factors. There is a close association between treatment with antipsychotic medication and weight gain, diabetes mellitus, sudden death, cardiac and endocrine complications such as QT prolongation and also hyperprolactinemia.

Conclusion: The paper highlights the importance of monitoring physical problems in patients with serious and enduring mental illnesses. Good practice points include help with smoking cessation, psycho-education about healthy lifestyle, close liaison between carers and professionals, the importance of taking baseline investigations before commencing antipsychotics, a shared care approach with primary care, early identification of the risk factors for physical illnesses and regular monitoring of physical health. Also important are social interventions such as appropriate accommodation and structured day, leisure and sporting activities.

Keywords

Physical healthschizophreniametabolic syndromerisk factorsdiabetes mellitusantipsychotic medicationcardiac arrhythmiasendocrine illnesses
Type
Original Article
Information
Journal of Psychiatric Intensive Care , Volume 3 , Issue 2 , July 2007 , pp. 101 - 111
Copyright
Copyright © NAPICU 2007

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