People with severe mental illness have lives 16 years shorter than does the general population, but in these patients coronary heart disease, not suicide, is the major cause of death. The lead Editorial in this week's Lancet says that physical health must not be forgotten in patients with serious mental health conditions that take antipsychotic drugs.
A recent Archives of General Psychiatry paper showed that found that patients taking one of a wide range of antipsychotic drugs commonly put on up to 5kg to 6kg in weight in the first 6-8 weeks of treatment. Although these patients have lower mortality than their fellow patients not treated with antipsychotics, their physical health on average much poorer than that of the general population. The Editorial says: "The combination of antipsychotic side-effects with poor diet, physical inactivity, high rates of smoking, and other factors associated with psychotic illness, together with socioeconomic deprivation, has a devastating effect on cardiometabolic health... If existing antipsychotics are here to stay—at least for the foreseeable future—what can be done to ameliorate their effects and improve patients' cardiometabolic health?"
The Editorial applauds the UK Government's Mental Health Strategy—that aims to improve the physical health of those with serious mental illness—but laments the lack of detail and apparent focus on just one risk factor: smoking. It says: "The solutions are more complex: but, as researchers have shown, interventions for smoking cessation and weight loss are effective in patients with severe mental illness."
But who should be taking responsibility for improving physical health? The Editorial notes that while this is traditionally the remit of primary care services, some patients with serious mental health conditions will see their mental health team much more frequently and thus may prefer to also be physically monitored by this team. Patients should be screened for their physical status upon entering mental health care, since, as the Editorial says, "It is only logical to begin physical health interventions concurrently".
The Editorial adds: "A lack of training in physical health issues is worrying in psychiatric doctors and nurses alike. In view of the wealth of evidence about the interconnections between mental health, physical health, and prescribed medication, postgraduate psychiatric training should prioritise up-to-date knowledge about evidence-based management of cardiometabolic disease."
It concludes: "Antipsychotic drugs are a clear risk to cardiometabolic health. This risk is, all too often, a necessary one. But the trade-off between mental and physical wellbeing is one that no patient should be forced to make. The mind–body dichotomy is both outdated and dangerous. The price of good mental health must not be a lifetime of physical illness."
The Lancet Press Office. T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com
For full Editorial see: http://press.thelancet.com/leaded1902.pdf
Journal
The Lancet