Notes on Physical Health and Schizophrenia

Main Physical Health Problems in Schizophrenia

People with schizophrenia have a reduced life expectancy (15 to 25 years younger than the general population)
Common causes of excessive mortality:

  • Suicide: Approximately 5% of individuals with schizophrenia die by suicide. (Source: Waidmann, T. A., & Smith, K. E. (2020))

  • Physical health causes significantly contribute to excess deaths.

Types of Physical Health Issues

  • Cardiovascular Disease (CVD): Increased risk due to lifestyle factors like smoking, obesity, and diabetes. Example statistical data:

    • Mortality rates from CVD for ages 20-34: 54.9 (SMR: 4.5) (Source: Laursen, T. M. (2011))

    • 35-54: 296.4 (SMR: 3.2)

    • 55-64: 1128.4 (SMR: 4.0)

  • Obesity: Higher likelihood (2.8 to 3.5 times) in individuals with schizophrenia. (Source: McCreadie, R. G. (2007))

  • Diabetes Mellitus (DM): Prevalence in schizophrenia is double that of the general population, with significant lifestyle impacts. (Source: Mitchell, A. J., et al. (2013))

  • Metabolic Syndrome: Features include:

    • Central obesity, hypertension, dyslipidemia.

    • High risk of developing Type II diabetes.

  • Other Health Concerns: Oral health, respiratory diseases, cancers, and sexual dysfunction.

Causes of Physical Health Problems

  • Lifestyle Factors:
    Cigarette smoking, alcohol consumption, poor diet, lack of exercise.

  • Genetic contributions towards diabetes and metabolic issues in patients with schizophrenia (e.g., family histories of diabetes linked to psychosis). (Source: Agerbo, E., et al. (2004))

Impact of Antipsychotic Medications

  • Second-generation antipsychotics are linked to weight gain and increased diabetes risk, particularly through 5HT2C serotonin receptor blockade. (Source: Juckel, G., et al. (2016))

  • Antipsychotic treatment, particularly with Clozapine, shows lower mortality compared to no treatment. (Source: Tandon, R., et al. (2015))

Screening and Monitoring

  • Essential assessments include:

    • Family history, smoking/alcohol history, BMI, waist circumference.

    • Blood pressure, plasma glucose, HbA1c.

  • Continuous monitoring is vital due to systematic neglect in physical health checks.

Barriers to Effective Treatment

  • Patient Factors:
    Fear, chaotic lifestyle, difficulty identifying symptoms, and poor health communication.

  • Healthcare Factors:
    Diagnostic overshadowing, poor inter-professional communication, lack of physical health training among psychiatrists, and stigma. (Source: Thornicroft, G., et al. (2016))

  • Disparities in care often arise despite clear guidelines and recommendations for health integration.

Summary

High rates of physical health issues lead to increased morbidity and mortality in individuals with schizophrenia.
Key focus areas for intervention include:

  • Improving lifestyle factors, effective medication management, regular screening, and addressing barriers to care.
    Recent policies aim to enhance physical health outcomes in patients with mental health disorders, although improvements are still required