Comorbid Somatic Illnesses in Patients With Severe Mental Disorders

Department of Biological Psychiatry, Medical University Innsbruck, Innsbruck, Austria.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2008; 69(4):514-9. DOI: 10.4088/JCP.v69n0401
Source: PubMed


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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    • "medical conditions excluding suicide and accidents ) (Brown et al., 2010; Nordentoft et al., 2013). The mortality gap is between 20% and 25% compared to the general population (Fleischhacker et al., 2008; Laursen, 2011; Laursen et al., 2014b) and has widened over time with improved treatments and availability of medical services that are less utilized by the severely mentally ill (Saha et al., 2007). Cardio-vascular and metabolic (hereinafter called cardiometabolic) disorders (CMD) are known to be the leading medical cause of excess mortality in psychosis (Chwastiak et al., 2006; Osborn et al., 2008; Laursen et al., 2009; Woodhead et al., 2014). "
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    ABSTRACT: Elevated prevalence of comorbid cardio-vascular and metabolic dysfunction (CMD) is consistently reported in patients with severe psychotic disorders such as schizophrenia (SZ), schizoaffective (SZA) and bipolar disorder (BP-P). Since both psychosis and CMD are substantively heritable in nature, we attempted to investigate the occurrence of CMD disorders in first-degree relatives of probands with psychosis. Our sample included 861 probands with a diagnosis of SZ (n=354), SZA (n=212) and BP-P (n=295), 776 first-degree relatives of probands and 416 healthy controls. Logistic regression was used to compare prevalence of any CMD disorders (diabetes, hypertension, hyperlipidemia or coronary artery disease) across groups. Post hoc tests of independence checked for CMD prevalence across psychosis diagnosis (SZ, SZA and BP-P), both in relatives of probands and within probands themselves. After controlling for potential confounders, first-degree relatives with (p<0.001) and without (p=0.03) Axis I non-psychotic or Axis- II cluster disorders were at a significant risk for CMD compared to controls. No significant difference (p=0.42) was observed in prevalence of CMD between relatives of SZ, SZA and BP-P, or between psychosis diagnoses for probands (p=0.25). Prevalence of CMD was increased in the first-degree relatives of psychosis subjects. This finding suggests the possibility of overlapping genetic contributions to CMD and psychosis. Increased somatic disease burden in relatives of psychotic disorder probands points to need for early detection and preventive efforts in this population. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Apr 2015 · Schizophrenia Research
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    • "Antipsychotic drugs have been prescribed in 31.1% of youth visits to psychiatrists, approximately the same proportion as with adults (Olfson et al., 2012a). Although the use of atypical antipsychotic drugs is associated with beneficial effects in patients with neuropsychiatric disorders , they are also associated with adverse metabolic effects such as weight gain, increased adiposity, dyslipidemia, inflammation , glucose intolerance and insulin resistance, and consequently with a higher risk of developing obesity, T2DM and cardiovascular disease (Table 2) (De Hert et al., 2009; Fleischhacker et al., 2008). The adverse effects are most prominent in patients with a first episode of schizophrenia, especially in those who have not previously taken antipsychotic drugs (Correll et al., 2011), children and adolescents (Almandil et al., 2013; De Hert et al., 2011). "
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    ABSTRACT: The use of antipsychotic drugs for the treatment of mood disorders and psychosis has increased dramatically over the last decade. Despite its consumption being associated with beneficial neuropsychiatric effects in patients, atypical antipsychotics (which are the most frequently prescribed antipsychotics) use is accompanied by some secondary adverse metabolic effects such as weight gain, dyslipidemia and glucose intolerance. The molecular mechanisms underlying these adverse effects are not fully understood but have been suggested to involve a dysregulation of adipose tissue homeostasis. As such, the aim of this paper is to review and discuss the role of adipose tissue in the development of secondary adverse metabolic effects induced by atypical antipsychotics. Data analyzed in this article suggest that atypical antipsychotics may increase adipose tissue (particularly visceral adipose tissue) lipogenesis, differentiation/hyperplasia, pro-inflammatory mediator secretion and insulin resistance and decrease adipose tissue lipolysis. Consequently, patients receiving antipsychotic medication could be at risk of developing obesity, type 2 diabetes and cardiovascular disease. A better knowledge of the impact of these drugs on adipose tissue homeostasis may unveil strategies to develop novel antipsychotic drugs with less adverse metabolic effects and to develop adjuvant therapies (e.g. behavioral and nutritional therapies) to neuropsychiatric patients receiving antipsychotic medication. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.
    Full-text · Article · Dec 2014 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
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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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    ABSTRACT: Abstract Individuals with serious mental illnesses (SMI) treated in the public mental health sector die decades younger than the general population. Poor quality and fragmentation of care are risk factors underlying the poor health of this population. Integrated electronic health records (EHR) can play a vital role in efforts to improve quality and outcomes of care in patients with SMI. The objective of this paper is to describe the current state of efforts to integrate and improve the mental and physical care of individuals with SMI in the public sector, with an emphasis on the use of electronic health records (EHR). While a range of encouraging initiatives exists throughout the country, technological and medico-legal challenges are providing significant barriers for the successful integration of care and EHRs for many partnering organizations. Furthermore, there is a lack of rigorous research studying the effectiveness and sustainability of these programmes. Recommendations are made for the alleviation of policy barriers and future areas of inquiry.
    Full-text · Article · Dec 2014 · International Review of Psychiatry
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