Balancing the Equation: Managing Comorbidities in Patients With Severe Mental Illness

Abstract

ersistent mental illnesses, notably schizophrenia and bipolar disorder, are often associated with substantial P psychosocial impairment and decreased quality of life. Most individuals with these conditions are also differentially affected by chronic medical disorders that are associated with a more severe mental illness presentation, course, and outcome. Moreover, cardiometabolic disorders are the most frequent cause of premature mortality in these populations. Notwithstanding the hazards posed by medical comorbidity, most individuals with chronic medical disorders are undiagnosed, and, as a result, receive guideline discordant care for their somatic health issues. As outlined in my article in this supplement, the Understanding Needs, Interactions, Treatments, and Expectations (UNITE) Global Survey sought to determine the extent of knowledge about somatic health issues possessed by patients with schizophrenia or bipolar disorder as well as their attitudes about interactions with their health care providers. The UNITE survey is one of the largest Internet-based studies ever conducted in a mixed group of individuals with bipolar disorder and schizophrenia. Further, the results of the UNITE survey expand and refine our knowledge about metabolic disruption and consequent medical comorbidity caused by weight gain– inducing medication, which is a primary area of distress for patients, a frequent reason for treatment discontinuation, and an issue that is infrequently monitored by practitioners. Next in this supplement, Susan L. McElroy, MD, reviews evidence for a bidirectional relationship between persistent mental illness and overweight/obesity. Pragmatic approaches to opportunistic screening, detection, diagnosis, and manage-