Comorbid Somatic Illnesses in Patients With Severe Mental Disorders: Clinical, Policy, and Research Challenges
Abstract
BACKGROUND: 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. PARTICIPANTS: 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. CONSENSUS PROCESS: 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. EVIDENCE: 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. CONCLUSIONS: 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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Self-harm is a marker of quality of life and emotional distress in individuals with SMI.
“Self-harm is also a marker of quality of life and emotional distress in individuals with SMI.36”
From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [36]
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Owen-Smith, A., Stewart, C., Sesay, M. M., Strasser, S. M., Yarborough, B. J., Ahmedani, B., Miller-Matero, L. R., Waring, S. C., Haller, I. V., Waitzfelder, B. E., et al. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-2456-1 · Cited by 54 · see citing works
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“…and adiposity could provide a stronger rationale for psychosocial interventions aimed at rectifying disrupted routines, not only to target mood symptoms, but also to reduce the obesity-driven medical co-morbidity observed in this population (Fleischhacker et al., 2008; Soreca et al., 2008).”
BackgroundCardiovascular Disease in Clozapine-Treated Patients: Evidence, Mechanisms and Management
Ronaldson, K. J. (2017) · CNS Drugs · doi:10.1007/s40263-017-0461-9 · Cited by 55 · see citing works
“Similar reductions in life expectancy are seen in all high-income countries and the situation is unlikely to be better in low- and middle-income countries [130].”
van Hasselt, F. M., Oud, M., & LOONEN, A. J. M. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-426 · Cited by 52 · see citing works
“A similar request was formulated as a request for parity in health care by a meeting of expert professionals on physical health care for patients with SMI [18].”
BackgroundDeclarative memory deficits and schizophrenia: Problems and prospects
Stone, W. S., & Hsi, X. (2011) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2011.04.006 · Cited by 50 · see citing works
for the HELPS Network, Park, A., McDaid, D., Weiser, P., von Gottberg, C., Becker, T. M., & Kilian, R. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-787 · Cited by 49 · see citing works
“disorder [8,9].”
Performance Measurement for Health System ImprovementPreprint
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Somatic comorbidity in children and adolescents with psychiatric disorders
Agnafors, S., Kjellström, A. N., Torgerson, J., & Rusner, M. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01313-9 · Cited by 50 · see citing works
S3 guideline on psychosocial therapies in severe mental illness: evidence and recommendations
Gühne, U., Weinmann, S., Arnold, K., Becker, T. M., & Riedel-Heller, S. G. (2014) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-014-0558-9 · Cited by 48 · see citing works
Patterns of chronic physical multimorbidity in psychiatric and general population
Filipčić, I., Filipčić, I. Š., Grošić, V., Bakija, I., Šago, D., Benjak, T., Uglešić, B., Bajić, Ž., & Sartorius, N. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.09.011 · Cited by 50 · see citing works
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“Despite rising awareness, diabetes may be one of the comorbidities easily missed in individuals with SMD (29, 30).”
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“People with serious mental illnesses (SMI) such as schizophrenia, bipolar disorder and major depressive disorder, have poorer physical health and significantly reduced life expectancy compared with the general population [1].”
BackgroundKaravidas, M. K., Lehrer, P. M., Escobar, J. I., Gara, M. A., Kotay, A., & Liu, R. (2011) · Psychosomatics · doi:10.1016/j.psym.2011.01.015 · Cited by 47 · see citing works
Callaghan, R. C., & Khizar, A. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.06.029 · Cited by 46 · see citing works
Gothefors, D., Adolfsson, R., Attvall, S., Erlinge, D., Jarbin, H., Lindström, K., von Hausswolff‐Juhlin, Y., Morgell, R., Toft, E., & Ösby, U. (2010) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2010.500397 · Cited by 46 · see citing works
Self-citationBody Mass Index as a Moderator of Treatment Response to Ketamine for Major Depressive Disorder
Freeman, M. P., Hock, R. S., Papakostas, G. I., Judge, H., Cusin, C., Mathew, S. J., Sanacora, G., Iosifescu, D. V., DeBattista, C., Trivedi, M. H., et al. (2020) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001209 · Cited by 44 · see citing works
“This finding is consistent with 2 previous reports in which greater antidepressant response to ketamine was positively correlated with greater BMI.12,13 The finding that continuous and categorical analyses of BMI were associated with antidepressant response, if consistently found in other studies, might help assist tr…”
BackgroundInfluentialCare for patients with severe mental illness: the general practitioner's role perspective
Oud, M., Schuling, J., Slooff, C. J., Groenier, K. H., Dekker, J. H., & Jong, B. M. (2009) · BMC Family Practice · doi:10.1186/1471-2296-10-29 · Cited by 44 · see citing works
“Also, that the integration of general somatic and psychiatric care services is less than optimal [25,26].”
BackgroundDiabetes and psychiatric illness in the total population of Stockholm
Wändell, P. E., Ljunggren, G., Wahlström, L., & Carlsson, A. C. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.06.012 · Cited by 42 · see citing works
“Somatic health among people with psychiatric disorders is not always given high priority [21].”
BackgroundA systematic review of palliative care tools and interventions for people with severe mental illness
den Boer, K., de Veer, A. J. E., Schoonmade, L. J., Verhaegh, K. J., van Meijel, B., & Francke, A. L. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2078-7 · Cited by 42 · see citing works
“eral population, and less attention has been paid so far to specific groups, such as people with severe mental illness (SMI) [5].”
BackgroundIncreased cardiometabolic dysfunction in first-degree relatives of patients with psychotic disorders
Mothi, S. S., Tandon, N., Padmanabhan, J. L., Mathew, I. T., Clementz, B. A., Tamminga, C. A., Pearlson, G. D., Sweeney, J. A., & Keshavan, M. S. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.03.034 · Cited by 41 · see citing works
“(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).”
BackgroundManagement of physical health in patients with schizophrenia: practical recommendations
Heald, A. H., Montejo, A. L., Millar, H. L., Hert, M. A. F. D., McCrae, J., & Correll, C. U. (2010) · European Psychiatry · doi:10.1016/s0924-9338(10)71706-5 · Cited by 41 · see citing works
“The psychiatrist is responsible for antipsychotic therapy, which has a significant impact on physical health [6,10].”
BackgroundWhy are somatic diseases in bipolar disorder insufficiently treated?
Nielsen, R. E., Kugathasan, P., Straszek, S. P. V., Jensen, S. E., & Licht, R. W. (2019) · International Journal of Bipolar Disorders · doi:10.1186/s40345-019-0147-y · Cited by 42 · see citing works
Beebe, L. H., & Smith, K. (2009) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2009.03.001 · Cited by 39 · see citing works
“Death rates from diabetes, respiratory/ cardiovascular, and other obesity-related illnesses are significantly higher among the over 2 million Americans with these disorders than in the general population (Fleischhacker et al, 2008).”
BackgroundBinder, M. D., Mittoux, A., He, Y., & Peuskens, J. (2010) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-010-0142-x · Cited by 38 · see citing works
“People with severe mental illness have nearly twice the normal risk of dying from cardiovascular disease (CVD) [ 16 , 23, 27, 40, 41, 44, 54].”
BackgroundSelf-citationQuality assurance in psychiatry: quality indicators and guideline implementation
Wobrock, T., Weinmann, S., Falkai, P., et al. (2009) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-009-0072-7 · Cited by 37 · see citing works
“Studies in some countries have found medical conditions and co-morbidities to be under-detected and under-treated in individuals with psychiatric disorders [11].”
BackgroundBinder, M. D., Mauri, M., Shaw, K., Wetterling, T., Doble, A., Giudicelli, A., & Falissard, B. (2010) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.322 · Cited by 36 · see citing works
“An apparently elevated risk of diabetes is not the only such risk observed in patients with schizophrenia; morbidity and mortality from cardiovascular disease are generally high (Brown et al., 2000; Fleischhacker et al., 2008; Osby et al., 2000).”
BackgroundSelf-citation
- Authors
- Fleishhacker, W. W., Cetkovich-Bakmas, M., De Hert, M., Hennekens, C. H., Lambert, M., Leucht, S., Maj, M., McIntyre, R. S., Naber, D., Newcomer, J. W., Olfson, M., Ösby, U., Sartorius, N., & Lieberman, J. A.
- Affiliations
- Innsbruck Medical University (AT)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2008-04-15
- Volume
- 69
- Issue
- 4
- Pages
- 514-519
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2043197463
- Cited by
- 328
- References
- 0
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 7 · 2023: 8 · 2022: 8 · 2021: 8 · 2020: 13 · 2019: 19 · 2018: 14 · 2017: 18 · 2016: 16 · 2015: 19 · 2014: 21 · 2013: 26 · 2012: 18
- FWCI
- 51.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- somatic comorbidity, severe mental illness, schizophrenia, bipolar disorder, physical health, cardiovascular disease, life expectancy, health care needs, health disparities, long-term psychiatric treatment
- MeSH terms
- Bipolar Disorder, Cardiovascular Diseases, Curriculum, Education, Medical, Health Personnel, Health Policy, Health Services Accessibility, Health Services Administration, Health Services Needs and Demand, Health Status, Humans, Life Expectancy, Mental Health Services, Obesity, Professional Competence, Schizophrenia, Somatoform Disorders, Comorbidity, Developed Countries, Biomedical Research
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