Article

Comorbid somatic illnesses in patients with severe mental disorders: Clinical, policy, and research challenges

Department of Biological Psychiatry, Medical University Innsbruck, Innsbruck, Austria.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 05/2008; 69(4):514-9. DOI: 10.4088/JCP.v69n0401
Source: PubMed

ABSTRACT An increasing body of evidence suggests that, in comparison to the general population, patients with severe mental illnesses such as schizophrenia or bipolar disorder have worse physical health and a far shorter life expectancy in developed countries, due primarily to premature cardiovascular disease.
This article is based on presentations and discussion on somatic comorbidity in psychiatric illnesses by a group of 37 international experts during 2 meetings held in 2006.
At the preparatory meeting in Paris, France, the group determined key topics for presentations and group discussions. During the meeting in Vienna, Austria, on day 1, each set of presentations was followed by discussions in small groups with the meeting participants. On day 2, conclusions reached by each discussion group were presented and used as a platform for a consensus view adopted by the meeting participants. The presentations and discussions were collated into a draft that was revised and approved by each of the bylined authors.
General health care needs are commonly neglected in patients with severe mental illness, with suboptimal integration of general somatic and psychiatric care services, current lack of consensus as to which health care professionals should be responsible for the prevention and management of comorbid somatic illnesses in patients with severe mental disorders, and, at least in some countries, a paucity of funding for general somatic care for patients with severe mental disorders, especially those in long-term psychiatric treatment.
The somatic health of patients with severe medical illnesses is too often neglected, thus contributing to an egregious health disparity. The reintegration of psychiatry and medicine, with an ultimate goal of providing optimal services to this vulnerable patient population, represents the most important challenge for psychiatry today, requiring urgent and comprehensive action from the profession toward achieving an optimal solution.

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    • "This dramatic mortality gap is largely due to preventable chronic diseases such as cardiovascular and metabolic conditions (De Hert et al., 2011). One critical factor contributing to the excess morbidity and mortality seen in individuals with SMI is poor quality of medical care (Fleischhacker et al., 2008). For instance, research indicates that poor quality of care may explain as much as half of excess mortality after hospitalizations for myocardial infarction in this patient group (Druss et al., 2007). "
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