Physical health in schizophrenia
Encyclopedia
People with schizophrenia
are at higher than average risk of physical ill health
and die earlier than the general population from natural causes. The fatal conditions include cardiovascular
, respiratory
and metabolic disorders.
Although death
by suicide
in schizophrenia has received much needed attention, death from cardiovascular disease is far more common, accounting for up to 75 percent of deaths. The causes of physical health problems include factors associated with mental illness
and its treatment, poverty
, poor housing, higher rates of smoking
, poor diet
and lack of exercise.
s overlook their physical health needs. Service users would like mental health practitioners to do more for their physical health. Rethink interviewed 2,998 mental health service users, over half of whom lived with a diagnosed
severe mental illness. Nearly one third said regular physical health checks were in their top three priorities for improving services. Mental health practitioners may feel unable to provide physical health input. Also there may be a feeling that people with mental health problems will not be interested in physical health education and support. In fact, much health promotion is simple and well received by service users. One review showed that people with schizophrenia benefited from a variety of behavioural interventions and achieved weight loss
and lifestyle change.
Another study found little evidence to support one intervention over another, but argued that moderately strenuous exercise was important.
However, a review of international guidelines for physical wellbeing in SMI has found that recommendations are variable. UK guidelines failed to address the specifics of physical health monitoring and lifestyle intervention, while US guidelines were more descriptive. Field studies suggested that all guidelines were inadequately implemented in practice.
The DoH in the UK has recommended wide-ranging action to enable the general population to choose healthier lifestyles in the Choosing Health white paper
.
In the UK the National Health Service
(NHS) is deeply split along physical/mental lines. Instead of treating whole people
, services tend to treat parts of people separately.
The commissioning framework to support the physical health needs of people with severe mental illness recommends a holistic approach with interagency collaboration.
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
are at higher than average risk of physical ill health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
and die earlier than the general population from natural causes. The fatal conditions include cardiovascular
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
, respiratory
Respiratory disease
Respiratory disease is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange possible in higher organisms, and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, and the...
and metabolic disorders.
Although death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
by suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
in schizophrenia has received much needed attention, death from cardiovascular disease is far more common, accounting for up to 75 percent of deaths. The causes of physical health problems include factors associated with mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
and its treatment, poverty
Poverty
Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...
, poor housing, higher rates of smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
, poor diet
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...
and lack of exercise.
Dynamics
Despite the high rates of physical health problems, mental health service users report that health care workerHealth care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
s overlook their physical health needs. Service users would like mental health practitioners to do more for their physical health. Rethink interviewed 2,998 mental health service users, over half of whom lived with a diagnosed
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
severe mental illness. Nearly one third said regular physical health checks were in their top three priorities for improving services. Mental health practitioners may feel unable to provide physical health input. Also there may be a feeling that people with mental health problems will not be interested in physical health education and support. In fact, much health promotion is simple and well received by service users. One review showed that people with schizophrenia benefited from a variety of behavioural interventions and achieved weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
and lifestyle change.
Another study found little evidence to support one intervention over another, but argued that moderately strenuous exercise was important.
Health policy
Many guidelines reflect the need to incorporate physical health care into mental health provision, including NICE in the UK. In primary care, the prodigy website provides practical and accessible advice.However, a review of international guidelines for physical wellbeing in SMI has found that recommendations are variable. UK guidelines failed to address the specifics of physical health monitoring and lifestyle intervention, while US guidelines were more descriptive. Field studies suggested that all guidelines were inadequately implemented in practice.
The DoH in the UK has recommended wide-ranging action to enable the general population to choose healthier lifestyles in the Choosing Health white paper
White paper
A white paper is an authoritative report or guide that helps solve a problem. White papers are used to educate readers and help people make decisions, and are often requested and used in politics, policy, business, and technical fields. In commercial use, the term has also come to refer to...
.
In the UK the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
(NHS) is deeply split along physical/mental lines. Instead of treating whole people
Holistic health
Holistic health is a concept in medical practice upholding that all aspects of people's needs, psychological, physical and social should be taken into account and seen as a whole. As defined above, the holistic view on treatment is widely accepted in medicine...
, services tend to treat parts of people separately.
The commissioning framework to support the physical health needs of people with severe mental illness recommends a holistic approach with interagency collaboration.