Reintegrating physical and mental health

Question 1

How much shorter on av do people wtih schizo live?

Answer 1

15-25 years

Question 2

What are the main cases of excess deaths among people with schizo

Answer 2

~5 % suicide
physical health comorbidites

Question 3

What are the main physical health comorbidities among schizo ppl?

Answer 3

Cardiovascular disease (CVD)
Obesity
Metabolic syndrome
Diabetes Mellitus (DM)
Also oral health, infectious diseases, respiratory disease,
cancer
Sexual disfunction –> linked to medication nonadhesion

Question 4

Metabolic Syndrome

Answer 4

Features: central obesity, hypertension, dyslipidemia, glucose intolerance or insulin resistance

5-6-fold increase in risk of type II diabetes mellitus
2-3-fold increase in mortality from CHD

Question 5

Is psychosis a multisystem disorder?

Answer 5

It would appear so,
Pillinger et al., 2019: Systematic meta-review assessing effect sizes for CNS and non-CNS dysfunction in FEP vs HC
Alterations were found in:
* Immune system
* Cardiometabolic system
* HPA
* Brain structure
* Neurophysiology
* Neurochemistry

Question 6

Physical health care issues

Answer 6

Many people with schizophrenia do not receive baseline tests assessing metabolic factors

Poorer quality of care of diabetes mellitus (DM) in those with schizophrenia. E.g. CATIE schizophrenia study, non-treatment rate for DM was 45%

Fewer follow-up tests of HbA1c, fasting lipids and retinal examinations despite clear guidelines for DM care

Question 7

Why are there issues with physical care provided to people with psychosis?

Answer 7

Can be due to stigma from self and health care proffesionals

Diagnostic overshadowing

Lack of patient engagement due to their symptoms

Difficulty getting access to health care

Question 8

Medical reasons for FEP

Answer 8

• Space-occupying lesion, CVA or other abnormality (MRI)
• Endocrine: hyper/hypothyroidism
• Low levels of B12 and folate
• Abnormalities in calcium/sodium/potassium levels
• Infection and inflammation: Syphilis, HIV, Hepatitis B, Hepatitis C
• Autoantibody mediated encephalitis or systemic lupus erythematous (NMDA, VGKC)

Question 9

What are patient factors which work as barriers for monitoring and treating physical health conditions?

Answer 9

Patient factors:
* Fear
* Chaotic lifestyle
* Difficulty identifying symptoms
* Difficulty communicating health concerns to health
professionals
* Remembering and engaging with appointments of
motivation
* Lack of education

Question 10

What are healthcare factors which work as barriers for monitoring and treating physical health conditions?

Answer 10

Healthcare factors:
* Diagnostic overshadowing – attribution of physical
symptoms to mental illness
* Poor communication with client or physical health
professional
* Psychiatrists lack of knowledge of physical health
* Sub-optimal care and lack of monitoring
* Stigma
* Complexity of treating both mental and physical health