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Cited by 205Mental Health Treatment and AccessSchizophrenia research and treatmentChronic Disease Management Strategies

The effects of undertreated chronic medical illnesses in patients with severe mental disorders.

Open access
Fagiolini, Andrea, Goracci, Arianna·2009·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.7075su1c.04
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Abstract

Severe mental disorders such as bipolar disorder and schizophrenia often co-occur with chronic medical illnesses, especially cardiovascular disease and diabetes. These comorbidities are associated with a more severe course of mental illness, reduced quality of life, and premature mortality. Although the association between mental disorders and physical health complications has long been recognized, medical conditions remain undertreated in clinical psychiatric practice, and the life expectancy for individuals with serious psychiatric disorders is approximately 30% shorter than that of the general US population. Factors that are related to the mental illness (eg, cognitive impairment, reduced ability to function, and a lack of communication skills) as well as factors such as the high cost of medical care may make accessing general health care a difficult task for patients. Even when medical care is received by patients, the quality is often poor, and dangerous illnesses may be undiagnosed and untreated. In addition, harmful side effects of medications used to treat psychiatric disorders, unhealthy habits and lifestyles, and a possible genetic susceptibility to medical conditions increase the likelihood of comorbid physical conditions in patients with severe mental illness. Implementing behavioral interventions into clinical practice may help patients improve their overall health and prevent chronic medical conditions.

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  • Long-term antipsychotic use and adverse lifestyle choices (e.g. obesity, smoking, poor diet, illicit drug use, and physical inactivity) are implicated in increased risk of cardiovascular events in these populations.

    “Long-term antipsychotic use and adverse lifestyle choices (e.g. obesity, smoking, poor diet, illicit drug use, and physical inactivity) are implicated in increased risk of cardiovascular events in these populations [3], [19], [20], [22], [31]–[33]”

    From Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London (2011) · cites this paper as [3]

    The Medication Side Effects section says atypical antipsychotics increase the likelihood of cardiovascular disease, and the lifestyle discussion links inactivity, poor diet, and smoking to coronary heart disease. Our copy does not establish a risk specifically from long-term antipsychotic use or address illicit drug use as a cardiovascular risk factor; it discusses cardiovascular disease rather than cardiovascular events specifically. Page numbers were not available in our copy. (LLM, conf=0.86)

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  • Excess mortality associated with mental disorders has been demonstrated to be predominantly due to 'natural' causes.

    “Excess mortality associated with mental disorders has been demonstrated to be predominantly due to ‘natural’ causes [3], [5], [30], [31], [36]–[38]”

    From Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London (2011) · cites this paper as [3]

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Research works printed but not linked: 7

  1. Miniño AM, Heron M, Murphy SL, et al. Deaths: final data for 2004. Natl Vital Stat Rep. 2007;55(19):1-119.
  2. Fagiolini A, Frank E, Turkin S, et al. Metabolic syndrome in patients with bipolar disorder [letter]. J Clin Psychiatry. 2008;69(4):678-679.
  3. Brown S. Excess mortality of schizophrenia: a meta-analysis. Br J Psychiatry. 1997;171:502-508.
  4. Kilbourne AM, Rofey DL, McCarthy JF, et al. Nutrition and exercise behavior among patients with bipolar disorder. Bipolar Disord. 2007; 9(5):443-452.
  5. Arinami T, Yamada N, Yamakawa-Kobayashi K, et al. Methylenetetra- hydrofolate reductase variant and schizophrenia/depression. Am J Med Genet. 1997;74(5):526-528.
  6. Zeber JE, McCarthy JF, Bauer MS, et al. Self-reported access to general medical and psychiatric care among veterans with bipolar disorder. Psychiatr Serv. 2007;58(6):740.
  7. Frayne SM, Halanych JH, Miller DR, et al. Disparities in diabetes care: impact of mental illness. Arch Intern Med. 2005;165(22):2631-2638.

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Authors
Fagiolini, A., & Goracci, A.
Affiliations
University of Siena (IT)
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2009-06
Volume
70
Issue
suppl 3
Pages
22-29
ISSN
0160-6689 (ISSN-L)
DOI
10.4088/jcp.7075su1c.04
OpenAlex
W2095247706
Cited by
205
References
42
Citations by year
2026: 4 · 2025: 13 · 2024: 7 · 2023: 9 · 2022: 8 · 2021: 12 · 2020: 14 · 2019: 9 · 2018: 10 · 2017: 7 · 2016: 10 · 2015: 14 · 2014: 16 · 2013: 14 · 2012: 16
FWCI
2.69
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Use Siena air (University of Siena) (submittedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
severe mental illness, chronic disease, undertreatment, bipolar disorder, schizophrenia, cardiovascular disease, diabetes mellitus, comorbidities, premature mortality, health care access, adverse drug reactions, behavioral interventions, quality of life
MeSH terms
Mental Disorders, Cardiovascular Diseases, Chronic Disease, Diabetes Mellitus, Humans, Obesity, Quality of Life, Antipsychotic Agents, Comorbidity, Metabolic Syndrome

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