Physical health in schizophrenia

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People with schizophrenia are at a higher than average risk of physical ill health, and earlier death than the general population. [1] [2] [3] The fatal conditions include cardiovascular, respiratory and metabolic disorders. [4]

Contents

Although death by suicide in schizophrenia has received much needed attention, and is the leading cause of death among males, death from cardiovascular disease is more common in females, [5] accounting for up to 75 percent of deaths. [6] The causes of physical health problems include factors associated with mental illness and its treatment, poverty, poor housing, higher rates of smoking, poor diet and lack of exercise. [7] [8] [9] [10]

Dynamics

Despite the high rates of physical health problems, mental health service users report that health care workers overlook their physical health needs. [11] Service users would like mental health practitioners to do more for their physical health. Rethink [12] interviewed 2,998 mental health service users, over half of whom lived with a diagnosed severe mental illness. Nearly one third said regular physical health checks were in their top three priorities for improving services. Mental health practitioners may feel unable to provide physical health input. Also there may be a feeling that people with mental health problems will not be interested in physical health education and support. In fact, much health promotion is simple and well received by service users. One review showed that people with schizophrenia benefited from a variety of behavioural interventions and achieved weight loss and lifestyle change. [13]

Schizophrenia also affects the attendance to cancer screening which is seen as one of the factors leading to shorter life expectancy. For example, women with schizophrenia are half as likely to attend breast cancer screening compared to the general population. [2] [3]

Another study found little evidence to support one intervention over another, [14] but argued that moderately strenuous exercise was important.

Health policy

Many guidelines reflect the need to incorporate physical health care into mental health provision, including NICE [15] in the UK. In primary care, the prodigy website provides practical and accessible advice. [16]

However, a review of international guidelines for physical wellbeing in SMI has found that recommendations are variable. [17] UK guidelines failed to address the specifics of physical health monitoring and lifestyle intervention, while United States guidelines were more descriptive. Field studies suggested that all guidelines were inadequately implemented in practice.

The DoH in the UK has recommended wide-ranging action to enable the general population to choose healthier lifestyles in the Choosing Health white paper. [18]

In the UK the National Health Service (NHS) is deeply split along physical/mental lines. Instead of treating whole people, services tend to treat parts of people separately.

The commissioning framework to support the physical health needs of people with severe mental illness recommends a holistic approach with interagency collaboration. [19]

Medication

The current medical view is that all people with schizophrenia must take medications for the disorder. These antipsychotic medications have adverse effects such as weight gain and induce feelings of fatigue that inhibit physical activity. The request for the people with schizophrenia to exercise for cardiovascular health then take medications (originally named "major tranquilizers") that inhibit activity is a double bind. [20] [21]

See also

Related Research Articles

<span class="mw-page-title-main">Antipsychotic</span> Class of medications

Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions and disorganized thinking. Other symptoms include social withdrawal and flat affect. Symptoms typically develop gradually, begin during young adulthood, and in many cases are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders and obsessive–compulsive disorder.

<span class="mw-page-title-main">Clozapine</span> Atypical antipsychotic medication

Clozapine is the first atypical antipsychotic medication to have been discovered. It is usually used in tablet or liquid form for people diagnosed with schizophrenia who have had an inadequate response to other antipsychotics or who have been unable to tolerate other drugs due to extrapyramidal side effects. It is also used for the treatment of psychosis in Parkinson's disease. In the US it is also licensed for use in patients with recurrent suicidal behaviour associated with schizophrenia or schizoaffective disorder. It is regarded as the gold-standard treatment when other medication has been insufficiently effective and its use is recommended by multiple international treatment guidelines. Compared to other antipsychotic drug treatments, initiating and maintaining clozapine is complex, expensive and time-consuming. The role of clozapine in treatment-resistant schizophrenia was established by the Clozaril Collaborative Study Group Study #30 in which clozapine showed marked benefits compared to chlorpromazine in a group of patients with protracted psychosis and who had already shown an inadequate response to other antipsychotics. There are a range of different adverse effects and compulsory blood monitoring is required in most developed countries. Whilst there are significant side effects, clozapine remains the most effective treatment when one or more other antipsychotics have had an inadequate response, and clozapine use is associated with multiple improved outcomes including all cause mortality, suicide and reduced hospitalisation. In a network comparative meta-analysis of 15 antipsychotic drugs, clozapine was significantly more effective than all other drugs. Surveys of patient satisfaction show preference over other antipsychotics.

Delirium is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or multiple causes, which usually develops over the course of hours to days. As a syndrome, delirium presents with disturbances in attention, awareness, and higher-order cognition. People with delirium may experience other neuropsychiatric disturbances, including changes in psychomotor activity, disrupted sleep-wake cycle, emotional disturbances, disturbances of consciousness, or, altered state of consciousness, as well as perceptual disturbances, although these features are not required for diagnosis.

<span class="mw-page-title-main">Haloperidol</span> Typical antipsychotic medication

Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychosis, and hallucinations from alcohol withdrawal. It may be used by mouth or injection into a muscle or a vein. Haloperidol typically works within 30 to 60 minutes. A long-acting formulation may be used as an injection every four weeks by people with schizophrenia or related illnesses, who either forget or refuse to take the medication by mouth.

<span class="mw-page-title-main">Tardive dyskinesia</span> Neurological disorder featuring involuntary, repetitive body movements

Tardive dyskinesia (TD) is a disorder that results in involuntary repetitive body movements, which may include grimacing, sticking out the tongue or smacking the lips. Additionally, there may be rapid jerking movements or slow writhing movements. In about 20% of people with TD, the disorder interferes with daily functioning. Reversibility of the condition is determined primarily by severity of symptoms and how long the condition has been present before stopping the offending drug.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

Dual diagnosis is the condition of having a mental illness and a comorbid substance use disorder. There is considerable debate surrounding the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness and substance use disorder, or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

The management of schizophrenia usually involves many aspects including psychological, pharmacological, social, educational, and employment-related interventions directed to recovery, and reducing the impact of schizophrenia on quality of life, social functioning, and longevity.

In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.

A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors.

Early intervention in psychosis is a clinical approach to those experiencing symptoms of psychosis for the first time. It forms part of a new prevention paradigm for psychiatry and is leading to reform of mental health services, especially in the United Kingdom and Australia.

Schizophrenia and tobacco smoking have been historically associated. Smoking is known to harm the health of people with schizophrenia, and to negatively affect their cognition.

<span class="mw-page-title-main">Patrick McGorry</span> Australian psychiatrist

Patrick Dennistoun McGorry FAA FASSA FAHMS FRCP FRANZCP is an Irish-born Australian psychiatrist known for his development of the early intervention services for emerging mental disorders in young people.

<span class="mw-page-title-main">Prognosis of schizophrenia</span>

The prognosis of schizophrenia is varied at the individual level. In general it has great human and economics costs. It results in a decreased life expectancy of 12–15 years primarily due to its association with obesity, little exercise, and smoking, while an increased rate of suicide plays a lesser role. These differences in life expectancy increased between the 1970s and 1990s, and between the 1990s and 2000s. This difference has not substantially changed in Finland for example – where there is a health system with open access to care.

Electroconvulsive therapy (ECT) is a controversial therapy used to treat certain mental illnesses such as major depressive disorder, schizophrenia, depressed bipolar disorder, manic excitement, and catatonia. These disorders are difficult to live with and often very difficult to treat, leaving individuals suffering for long periods of time. In general, ECT is not looked at as a first line approach to treating a mental disorder, but rather a last resort treatment when medications such as antidepressants are not helpful in reducing the clinical manifestations.

Shubulade Smith is a British academic and consultant psychiatrist at the South London and Maudsley NHS Foundation Trust (SLaM). She is a senior lecturer at King's College, London and Clinical Director at the NCCMH and forensic services at SLaM, and is currently serving as the first black President of the Royal College of Psychiatrists.

Serious mental illness (SMI) is characterized as any mental health condition that impairs seriously or severely from one to several significant life activities, including day to day functioning. Four common examples of SMI include bipolar disorders, psychotic disorders, post-traumatic stress disorders, and major depressive disorders. People having SMI experience symptoms that prevent them from having experiences that contribute to a good quality of life, due to social, physical, and psychological limitations of their illnesses. In 2021, there was a 5.5% prevalence rate of U.S. adults diagnosed with SMI, with the highest percentage being in the 18 to 25 year-old group (11.4%). Also in the study, 65.4% of the 5.5% diagnosed adults with SMI received mental health care services.

References

  1. ↑ Elias M (2007-05-03). "Mentally ill die 25 years earlier, on average". Titre : Mentally ill die 25 years earlier, on average. USA Today 5/3/2007.
  2. 1 2 "Cancer screening across the world is failing people with mental illness". NIHR Evidence (Plain English summary). 2020-05-19. doi:10.3310/alert_40317. S2CID   243581455.
  3. 1 2 Solmi, Marco; Firth, Joseph; Miola, Alessandro; Fornaro, Michele; Frison, Elisabetta; Fusar-Poli, Paolo; Dragioti, Elena; Shin, Jae Il; Carvalho, Andrè F; Stubbs, Brendon; Koyanagi, Ai (28 November 2019). "Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people". The Lancet Psychiatry. 7 (1): 52–63. doi:10.1016/S2215-0366(19)30414-6. hdl: 11577/3383784 . PMID   31787585. S2CID   208535709.
  4. ↑ Harris EC, Barraclough B (July 1998). "Excess mortality of mental disorder". The British Journal of Psychiatry. 173: 11–53. doi:10.1192/bjp.173.1.11. PMID   9850203. S2CID   31951494.
  5. ↑ Javitt DC (June 2014). "Balancing therapeutic safety and efficacy to improve clinical and economic outcomes in schizophrenia: a clinical overview". The American Journal of Managed Care. 20 (8 Suppl): S160-5. PMID   25180705.
  6. ↑ Hennekens CH, Hennekens AR, Hollar D, Casey DE (December 2005). "Schizophrenia and increased risks of cardiovascular disease". American Heart Journal. 150 (6): 1115–21. doi:10.1016/j.ahj.2005.02.007. PMID   16338246.
  7. ↑ Phelan M, Stradins L, Morrison S (February 2001). "Physical health of people with severe mental illness". BMJ. 322 (7284): 443–4. doi:10.1136/bmj.322.7284.443. PMC   1119672 . PMID   11222406.
  8. ↑ Brown S, Birtwistle J, Roe L, Thompson C (May 1999). "The unhealthy lifestyle of people with schizophrenia". Psychological Medicine. 29 (3): 697–701. doi:10.1017/s0033291798008186. PMID   10405091. S2CID   42412030.
  9. ↑ McCreadie RG (December 2003). "Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study". The British Journal of Psychiatry. 183 (6): 534–9. doi: 10.1192/bjp.183.6.534 . PMID   14645025.
  10. ↑ Vancampfort D, Knapen J, Probst M, van Winkel R, Deckx S, Maurissen K, Peuskens J, De Hert M (May 2010). "Considering a frame of reference for physical activity research related to the cardiometabolic risk profile in schizophrenia". Psychiatry Research. 177 (3): 271–9. doi:10.1016/j.psychres.2010.03.011. PMID   20406713. S2CID   207447309.
  11. ↑ Malone V, Harrison R, Daker-White G (May 2018). "Mental health service user and staff perspectives on tobacco addiction and smoking cessation: A meta-synthesis of published qualitative studies". Journal of Psychiatric and Mental Health Nursing. 25 (4): 270–282. doi:10.1111/jpm.12458. PMID   29498459. S2CID   3688887. Archived from the original on 14 April 2018.
  12. ↑ "Rethink. Just one per cent". Kingston-Upon-Thames: Rethink. 2003.
  13. ↑ Bushe C, Haddad P, Peveler R, Pendlebury J (November 2005). "The role of lifestyle interventions and weight management in schizophrenia". Journal of Psychopharmacology. 19 (6 Suppl): 28–35. doi:10.1177/0269881105058682. PMID   16280335. S2CID   32882880.
  14. ↑ Richardson CR, Faulkner G, McDevitt J, Skrinar GS, Hutchinson DS, Piette JD (March 2005). "Integrating physical activity into mental health services for persons with serious mental illness". Psychiatric Services. 56 (3): 324–31. doi:10.1176/appi.ps.56.3.324. PMID   15746508.
  15. ↑ "Psychosis and schizophrenia in adults: prevention and management". National Institute for Health and Care Excellence (NICE).
  16. ↑ "Schizophrenia - Management Quick answers". NHS Institute for Innovation and Improvement. Archived from the original on 3 August 2008.
  17. ↑ Citrome L, Yeomans D (November 2005). "Do guidelines for severe mental illness promote physical health and well-being?". Journal of Psychopharmacology. 19 (6 Suppl): 102–9. doi:10.1177/0269881105059505. PMID   16280343. S2CID   8327581.
  18. ↑ (Choosing health: making healthy choices easier. 2004) http://www.dh.gov.uk/PublicationsAndStatistics/Publications/fs/en
  19. ↑ (Choosing health: supporting the physical needs of people with severe mental illness – commissioning framework. 2006.) http://www.dh.gov.uk/PublicationsAndStatistics/Publications/fs/en
  20. ↑ "Antipsychotic medications are indicated" APA and Schizophrenia.com
  21. ↑ King C, Voruganti LN (May 2002). "What's in a name? The evolution of the nomenclature of antipsychotic drugs". Journal of Psychiatry & Neuroscience. 27 (3): 168–75. PMC   161646 . PMID   12066446.
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