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Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level
Open accessAbstract
Physical disorders are, compared to the general population, more prevalent in people with severe mental illness (SMI). Although this excess morbidity and mortality is largely due to modifiable lifestyle risk factors, the screening and assessment of physical health aspects remains poor, even in developed countries. Moreover, specific patient, provider, treatment and system factors act as barriers to the recognition and to the management of physical diseases in people with SMI. Psychiatrists can play a pivotal role in the improvement of the physical health of these patients by expanding their task from clinical psychiatric care to the monitoring and treatment of crucial physical parameters. At a system level, actions are not easy to realize, especially for developing countries. However, at an individual level, even simple and very basic monitoring and treatment actions, undertaken by the treating clinician, can already improve the problem of suboptimal medical care in this population. Adhering to monitoring and treatment guidelines will result in a substantial enhancement of physical health outcomes. Furthermore, psychiatrists can help educate and motivate people with SMI to address their suboptimal lifestyle, including smoking, unhealthy diet and lack of exercise. The adoption of the recommendations presented in this paper across health care systems throughout the world will contribute to a significant improvement in the medical and related psychiatric health outcomes of patients with SMI.
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“Professional barriers to screening within mental health settings may in their turn reflect lack of clarity about whose clinical responsibility the screening is, lack of understanding about what should be measured and when, uncertainity about how to interpret results, and lack of access to necessary equipment 41 , as well as incomplete communication between primary and secondary care.”
From Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis (2016) · cites this paper as [41]
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Swaraj, S., Wang, M., Chung, D., Curtis, J., Firth, J., Ramanuj, P., Sara, G. E., & Large, M. M. B. (2019) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13073 · Cited by 39
“The reasons for elevated rates of natural deaths among the seriously mentally ill are thought to include the side-effects of psychotropic medication, self-neglect, lack of self-awareness regarding lifestyle behaviours influencing physical health, addictions such as smoking and alcohol, poor diet, diagnostic overshadow…”
BackgroundManagement of clozapine treatment during the COVID-19 pandemic
Gee, S., Gaughran, F., MacCabe, J. H., Shergill, S. S., Whiskey, E., & Taylor, D. M. (2020) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125320928167 · Cited by 36
Martland, R., Teasdale, S. B., Murray, R. M., Gardner-Sood, P., Smith, S. M., Ismail, K., Atakan, Z., Greenwood, K., Stubbs, B., & Gaughran, F. (2021) · Psychological Medicine · doi:10.1017/s0033291721003147 · Cited by 43
Hasan, A., Falkai, P., Lehmann, I., & Gäebel, W. (2020) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2020.0412 · Cited by 37
Chan, J. K. N., Chu, R. S. T., Hung, C., Law, J. W. Y., Wong, C. S. M., & Chang, W. C. (2022) · Schizophrenia Bulletin · doi:10.1093/schbul/sbac070 · Cited by 35
Monitoring of physical health in services for young people at ultra‐high risk of psychosis
Carney, R., Bradshaw, T., & Yung, A. R. (2015) · Early Intervention in Psychiatry · doi:10.1111/eip.12288 · Cited by 35
“Barriers to providing effective management and assessment of physical illness in mental health services have previously been discussed.(2,31) A key issue is a lack of clarity and consensus regarding with whom the responsibility lies.”
BackgroundTreatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review
Chidarikire, S., Cross, M., Skinner, I., & Cleary, M. L. (2017) · International Nursing Review · doi:10.1111/inr.12391 · Cited by 37
“den Hertog & Gilmoor (2016) South Africa To explore the dynamics of informal care for people with schizophrenia experiencing chronic psychotic symptoms Ethnographic study utilizing semi-structured interviews 4 people with chronic psychotic symptoms and 33 care givers The nuclear family retained the main responsibiliti…”
Exploring Patterns of Disturbed Eating in Psychosis: A Scoping Review
Stogios, N., Smith, E., Asgariroozbehani, R., Hamel, L., Gdanski, A., Selby, P. L., Sockalingam, S., Graff‐Guerrero, A., Taylor, V. H., Agarwal, S. M., et al. (2020) · Nutrients · doi:10.3390/nu12123883 · Cited by 36
“Moreover, it should also be considered that studies in chronic patients with SCZ are confounded by cumulative illness associated lifestyle factors and treatments, which may affect both eating patterns and weight gain [7,117].”
BackgroundGalderisi, S., Binder, M. D., Prato, S. D., Fagiolini, A. M., Gorwood, P. A. P. M., Leucht, S., Maggioni, A. P., Mucci, A., & Arango, C. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2020.115 · Cited by 35
“In patients without other metabolic risk factors treated with antipsychotics, 218 the EPA position paper and WPA guidelines (4, 30) recommend monitoring the CVD risk factors 219 after 6 and 12 weeks and then every 12 months to assess the risk profile of the administered drug.”
BackgroundSelf-citationSugai, T., Suzuki, Y., Yamazaki, M., Shimoda, K., Mori, T., Ozeki, Y., Matsuda, H., Sugawara, N., Yasui‐Furukori, N., Minami, Y., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008720 · Cited by 35
Diabetes, physical activity participation and exercise capacity in patients with schizophrenia
Vancampfort, D., De Hert, M., Sweers, K., De Herdt, A., Detraux, J., & Probst, M. (2013) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12077 · Cited by 34
“Patients with schizophrenia on average consume a diet higher in fat, higher in refined sugar, lower in fiber and poor in fruits and in vegetables.(37,38) Last, the current study had a cross-sectional nature.”
Self-citationVita, A., Nibbio, G., & Barlati, S. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116126 · Cited by 36
Swildens, W. E., Termorshuizen, F., de Ridder, A., Smeets, H. M., & Engelhard, I. M. (2015) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-015-0679-0 · Cited by 34
“…and a mean life expectancy that is at least 15 years shorter compared to the general population (Altamura et al. 2011; Carney et al. 2006; De Hert et al. 2011a; Wahlbeck et al. 2011; Weber Preliminary results of this study were presented as a poster presentation during the European Congress…”
BackgroundInfluentialKoyanagi, A., Oh, H. Y., Stubbs, B., Haro, J. M., & DeVylder, J. (2016) · Psychological Medicine · doi:10.1017/s0033291716002750 · Cited by 36
“…to healthcare [resulting in under-detection of risk factors (e.g. hypercholesterolemia, hypertension) of more serious health conditions, and/or suboptimal treatment for the physical health conditions] for those with co-morbid depression/PEs may also underlie our findings (De Hert et al. 2011a, b).”
ResultEskelinen, S., Sailas, E. S., Joutsenniemi, K., Holi, M. M., Koskela, T., & Suvisaari, J. (2017) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2017.1319497 · Cited by 34
“In receiving help for somatic complaints, patients with schizophrenia encounter several obstacles (12).”
BackgroundInfluentialSampogna, G., Fiorillo, A., Luciano, M., Vecchio, V. D., Steardo, L., Pocai, B., Barone, M., Amore, M., Pacitti, F., Dell’Osso, L., et al. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00235 · Cited by 36
Ferro, M. A., Lipman, E. L., Lieshout, R. J. V., Boyle, M. H., Gorter, J. W., MacMillan, H. L., González, A., & Georgiades, K. (2018) · Child Psychiatry & Human Development · doi:10.1007/s10578-018-0848-y · Cited by 35
A modality‐specific dysfunction of pain processing in schizophrenia
Zhou, L., Bi, Y., Liang, M., Kong, Y., Tu, Y., Zhang, X., Song, Y., Du, X., Tan, S., & Hu, L. (2019) · Human Brain Mapping · doi:10.1002/hbm.24906 · Cited by 33
van Hasselt, F. M., Oud, M. J. T., & LOONEN, A. J. M. (2014) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12372 · Cited by 34
Integrating Bipolar Disorder Management in Primary Care
Kilbourne, A. M., Goodrich, D. E., O’Donnell, A. N., & Miller, C. J. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0325-4 · Cited by 32
Prevalence of underweight in patients with schizophrenia: A meta-analysis
Sugawara, N., Maruo, K., Sugai, T., Suzuki, Y., Ozeki, Y., Shimoda, K., Someya, T., & Yasui‐Furukori, N. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.10.017 · Cited by 33
Chen, W., Chen, P., Pan, C., Su, S., Tsai, S., Chen, C.-C., & Kuo, C. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.07.014 · Cited by 32
Schizophrenia and Physical Comorbidity.
Filipčić, I. Š., & Filipčić, I. (2018) · PubMed · Cited by 32
Dong, R., Haque, A., Wu, H. E., Placide, J., Yu, L., & Zhang, X. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.110 · Cited by 31
Young, S. J., Praskova, A., Hayward, N., & Patterson, S. (2017) · Health & Social Care in the Community · doi:10.1111/hsc.12349 · Cited by 31
Richardson, A., Richard, L., Gunter, K. E., Cunningham, R., Hamer, H. P., Lockett, H., Wyeth, E., Stokes, T., Burke, M., Green, M., et al. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.05.021 · Cited by 34
Happell, B., Platania‐Phung, C., & Scott, D. S. (2013) · Issues in Mental Health Nursing · doi:10.3109/01612840.2012.733907 · Cited by 31
A Framework for Extending Psychiatrists’ Roles in Treating General Health Conditions
Vanderlip, E. R., Raney, L. E., & Druss, B. G. (2016) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.15070950 · Cited by 31
Rovers, J. J. E., van de Linde, L. S., Kenters, N., Bisseling, E., Nieuwenhuijse, D. F., Koopmans, M., Voss, A., & Nabuurs-Franssen, M. H. (2020) · Antimicrobial Resistance and Infection Control · doi:10.1186/s13756-020-00853-z · Cited by 31
Richardson, T. E., O’Reilly, C. L., & Chen, T. F. (2014) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-014-9997-7 · Cited by 37
“Therefore their knowledge of general medicine may be suboptimal and they may be unwilling to address general medical issues [38, 39].”
Heiberg, I. H., Nesvåg, R., Balteskard, L., Bramness, J. G., Hultman, C. M., Næss, Ø., Reichborn‐Kjennerud, T., Ystrøm, E., Jacobsen, B. K., & Høye, A. (2020) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13157 · Cited by 31
“The ability to navigate between psychiatric, primary, and specialized somatic healthcare systems may be a challenge, particularly for patients with SMI, and is potentially aggravated by a lack of clarity as to which health provider is responsible for monitoring the physical health of this patient group (60).”
BackgroundScott, E. M., Carpenter, J. S., Iorfino, F., Cross, S. P. M., Hermens, D. F., Gehue, J., Wilson, C. E., White, D., Naismith, S. L., Guastella, A. J., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-025674 · Cited by 28
“Much current work is focused on modifying risks in this subpopulation of young people who are engaged with secondary care or more specialised mental health services.(14) 32 33 Through the development of the headspace programme, however, we now have the opportunity for intervening earlier with a much larger at-risk pop…”
Background
Metadata
- Authors
- DE HERT, M., COHEN, D., BOBES, J., CETKOVICH‐BAKMAS, M., LEUCHT, S., NDETEI, D. M., NEWCOMER, J. W., UWAKWE, R., ASAI, I., MÖLLER, H., GAUTAM, S., DETRAUX, J., & CORRELL, C. U.
- Affiliations
- University of Groningen (NL)
- Universidad de Oviedo (ES)
- Technical University of Munich (DE)
- University of Nairobi (KE)
- Washington University in St. Louis (US)
- Nnamdi Azikiwe University (NG)
- SMS Medical College (IN)
- KU Leuven (BE)
- Albert Einstein College of Medicine (US)
- ORCID
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2011-06
- Volume
- 10
- Issue
- 2
- Pages
- 138-151
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC3104888
- OpenAlex
- W1828019950
- Cited by
- 870
- References
- 150
- Citations by year
- 2026: 39 · 2025: 50 · 2024: 50 · 2023: 57 · 2022: 68 · 2021: 54 · 2020: 72 · 2019: 76 · 2018: 68 · 2017: 56 · 2016: 79 · 2015: 57 · 2014: 37 · 2013: 57 · 2012: 39
- FWCI
- 31.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Pfizer
- Società Italiana di Psichiatria Biologica
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- physical illness, severe mental illness, barriers to care, physical health screening, treatment guidelines, lifestyle risk factors, smoking, diet, physical activity, developing countries
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