Physical health in schizophrenia

A recent phenomenon is that people with schizophrenia are at higher than average risk of physical ill health, and die earlier than the general population from natural causes.[1] The fatal conditions include cardiovascular, respiratory and metabolic disorders.[2]

Although death by suicide in schizophrenia has received much needed attention, death from cardiovascular disease is far more common, accounting for up to 75 percent of deaths.[3] 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.[4][5][6][7]

Dynamics

Despite the high rates of physical health problems, mental health service users report that health care workers overlook their physical health needs.[8] Service users would like mental health practitioners to do more for their physical health. Rethink[9] 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.[10]

Another study found little evidence to support one intervention over another,[11] 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[12] in the UK. In primary care, the prodigy website provides practical and accessible advice.[13]

However, a review of international guidelines for physical wellbeing in SMI has found that recommendations are variable.[14] 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.[15]

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.[16]

Medication

The current medical view is that all patients suffering from 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 schizophrenia sufferer to exercise for cardiovascular health then give medications (originally named "major tranquilizers") that inhibit activity is a double bind.[17][18]

gollark: tio!debug
gollark: ```c#define let char*#define var char#define auto int*#define fn int#define new malloc#include <stdio.h>#include <stdlib.h>#include <string.h>fn main() { let s = "abcdefghijklmnqoprastjasdhasdua"; let j_ = new(1024); strcpy(j_, s); auto q = j; fn x = 0x6F5D5F5F; q[0] = x; printf("%s", j_);}```
gollark: ```c#define let char*#define var char#define auto int*#define fn int#define new malloc#include <stdio.h>#include <stdlib.h>#include <string.h>fn main() { let s = "abcdefghijklmnqoprastjasdhasdua"; let j_ = new(1024); strcpy(j_, s); fn x = 4; j_[0] = x; printf("%s", j_);}```
gollark: It didn't segfault, that's why it's odd.
gollark: Odd.

See also
  • Schizophrenia and smoking

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. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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. Archived from the original on 14 April 2018.
  9. "Rethink. Just one per cent". Kingston-Upon-Thames: Rethink. 2003.
  10. 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.
  11. 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.
  12. "Psychosis and schizophrenia in adults: prevention and management". National Institute for Health and Care Excellence (NICE).
  13. "Schizophrenia - Management Quick answers". NHS Institute for Innovation and Improvement. Archived from the original on 3 August 2008.
  14. 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.
  15. (Choosing health: making healthy choices easier. 2004) http://www.dh.gov.uk/PublicationsAndStatistics/Publications/fs/en
  16. (Choosing health: supporting the physical needs of people with severe mental illness – commissioning framework. 2006.) http://www.dh.gov.uk/PublicationsAndStatistics/Publications/fs/en
  17. "Antipsychotic medications are indicated" APA and Schizophrenia.com
  18. 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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