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Psychiatrists and Schizophrenia Patients Need to Tackle Medical Health Issues

Marlene Busko

February 14, 2008 ? A Mental Health America online survey of 250 people with schizophrenia and 250 psychiatrists revealed that communication between the 2 groups could be better ? to address medical health issues that result in a 25-year shorter lifespan in these patients compared with the general population.

The survey, "Communicating About Health: A Mental Health America Survey of People With Schizophrenia and Providers," is available on the nonprofit organization's website.

"This survey tells us that mental health providers and people with schizophrenia must communicate more about issues like diet, exercise, and medication side effects if we?re to turn the tide of this public-health crisis and extend the lives of the millions of Americans with schizophrenia," said David Shern, PhD, president and CEO of Mental Health America, in a press release.

"Patients don?t know enough, and medical illness and lifestyle and behaviors that affect general medical health are not being consistently or sufficiently discussed by mental healthcare providers," Jeffrey A. Lieberman, MD, from Columbia University, in New York, who was not involved with the survey, told Medscape Psychiatry.

The survey was prompted by a report issued in October 2006 by the National Association of State Mental Health Program Directors showing that people with mental health illness die on average 25 years earlier than the general population. Deaths are largely from cardiovascular, respiratory, and infectious diseases, which have modifiable risk factors such as obesity and smoking. The report also highlighted the fact that some antipsychotic medications have adverse effects such as weight gain, diabetes, and dyslipidemia.

In late 2007, Mental Health America commissioned an online nationwide survey of 250 adults (age 18 years and older) diagnosed with schizophrenia and 250 psychiatrists. The margin of error of the survey was ? 6.2%.

The survey aimed to:

Examine how well overall health is addressed in mental health settings.
Examine the dialog between individuals with schizophrenia and psychiatrists about treatment options and potential adverse health effects.
Explore how well people with schizophrenia are aware of routine healthy living practices.
Patients in Poor Health

A total of 56% of the surveyed schizophrenia patients were female. The average age of the survey respondents was 38 years, and slightly more than half (52%) had a paid or unpaid job. Approximately 88% had health insurance.

Compared with the general population, the surveyed schizophrenia patients had a greater tendency to be obese (44% vs 26%) or have diabetes (23% vs 7.7%), hypertension (34% vs 22.9%), or hypercholesterolemia (36% vs 16.5%).

While most survey respondents reported having easy access to medical care, 27% reported that it was difficult to get medical care. Yet 83% of the respondents had visited a doctor or a nurse in the past year for a checkup or to discuss medical care.

Most respondents believed that their overall health affected their recovery from schizophrenia and that taking certain actions (being more physically active, having a regular schedule, and eating better) would improve their lifestyle.

Only about half of the respondents, however, reported that they expected their psychiatrists to focus on overall as well as mental health. Less than half reported that their psychiatrists had asked about their blood pressure, blood sugar, or cholesterol, although most respondents stated that their psychiatrists had asked about their sleep habits, physical activity, smoking, and medication adverse effects.

Caring for Both Brain and Body

The psychiatrists who responded to the survey had been practicing for an average of 12 years. Most reported applying the American Psychiatric Association/American Diabetes Association monitoring guidelines in their practice.

A total of 91% reported that they believed they were responsible for taking care of medical conditions that occur as a result of psychiatric care and for monitoring medical conditions that cause, trigger, or exacerbate psychiatric conditions, but only 73% reported feeling responsible for ensuring that patients receive appropriate care for all health problems.

Compared with the surveyed patients, the surveyed psychiatrists reported higher rates of regular discussions about many health issues, such as medication adverse effects (100% vs 79%), follow-up with medical doctors (98% vs 58%), or a patient's blood sugar level (88% vs 42%).

The main barriers to comprehensive care cited by the psychiatrists were lack of time during the typical office visit (83%) and a belief that psychiatrists were not as well equipped as primary care providers to deal with overall health (74%).

"Previously, the focus was really just on the brain and behavior and mental functions associated with the brain, but since this population suffers disproportionately from medical illnesses, there needs to be engagement with the patients on a broader level to include their general health status," said Dr. Lieberman.

"The survey itself is really a commendable effort to begin to address the problem," he noted.

The survey was funded by unrestricted educational grants from Solvay Pharmaceuticals and Wyeth Pharmaceuticals and from an anonymous donor
 

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