Toward the reintegration of psychiatry and medicine in patients with mental illness

Abstract

Treatment goals in schizophrenia and bipolar disorder are no longer simply the reduction of psychosis and manic or depressive episodes. Today's treatment goals encompass a broader improvement of quality of life and, as much as possible, the return of patients to premorbid levels of functioning. To achieve these wider-reaching goals, patient care must simultaneously address not only patients' psychiatric illness but also their medical problems. In addition to reducing mortality, there are good psychiatric reasons for addressing the physical well-being of patients: the presence of a comorbid physical illness worsens the prognosis of the mental disorder and vice versa. General medical monitoring should form as much a part of the routine management of patients with long-term mental illness as should psychiatric reviews, and any barriers between diagnosis and treatment in these patients should be examined. The care team needs to be expanded beyond the core psychiatric team, and patient access to primary medical care needs to be improved to ensure parity of medical treatment with the general population. As patient function improves, patients and their families can become more involved in self-management and feel empowered to affect their own outcomes.