Physical Health Problems In People Research Articles

The temporal relationship between severe mental illness diagnosis and chronic physical comorbidity: a UK primary care cohort study of disease burden over 10 years

Despite increased rates of physical health problems in people with schizophrenia, bipolar disorder, and other psychotic illnesses, the temporal relationship between physical disease acquisition and diagnosis of a severe mental illness remains unclear. We aimed to determine the cumulative prevalence of 24 chronic physical conditions in people with severe mental illness from 5 years before to 5 years after their diagnosis. In this cohort study, we used the UK Clinical Practice Research Datalink (CPRD) to identify patients aged 18-100 years who were diagnosed with severe mental illness between Jan 1, 2000, and Dec 31, 2018. Each patient with severe mental illness was matched with up to four individuals in the CPRD without severe mental illness by sex, 5-year age band, primary care practice, and year of primary care practice registration. Individuals in the matched cohort were assigned an index date equal to the date of severe mental illness diagnosis in the patient with severe mental illness to whom they were matched. Our primary outcome was the cumulative prevalence of 24 physical health conditions, based on the Charlson and Elixhauser comorbidity indices, at 5 years, 3 years, and 1 year before and after severe mental illness diagnosis and at the time of diagnosis. We used logistic regression to compare people with severe mental illness with the matched cohort, adjusting for key variables such as age, sex, and ethnicity. We identified 68 789 patients diagnosed with a severe mental illness between Jan 1, 2000, and Dec 31, 2018, and we matched them to 274 827 patients without a severe mental illness diagnosis. In both cohorts taken together, the median age was 40·90 years (IQR 29·46-56·00), 175 138 (50·97%) people were male, and 168 478 (49·03%) were female. The majority of patients were of White ethnicity (59 867 [87·03%] patients with a severe mental illness and 244 566 [88·99%] people in the matched cohort). The most prevalent conditions at the time of diagnosis in people with severe mental illness were asthma (10 581 [15·38%] of 68 789 patients), hypertension (8696 [12·64%]), diabetes (4897 [7·12%]), neurological disease (3484 [5·06%]), and hypothyroidism (2871 [4·17%]). At diagnosis, people with schizophrenia had increased odds of five of 24 chronic physical conditions compared with matched controls, and nine of 24 conditions were diagnosed less frequently than in matched controls. Individuals with bipolar disorder and other psychoses had increased odds of 15 conditions at diagnosis. At 5 years after severe mental illness diagnosis, these numbers had increased to 13 conditions for schizophrenia, 19 for bipolar disorder, and 16 for other psychoses. Elevated odds of multiple conditions at the point of severe mental illness diagnosis suggest that early intervention on physical health parameters is necessary to reduce morbidity and premature mortality. Some physical conditions might be under-recorded in patients with schizophrenia relative to patients with other severe mental illness subtypes. UK Office For Health Improvement and Disparities.

The complexities of the borderline patient: how much more complex when considering physical health?

Borderline Personality Disorder is associated with a substantially reduced life expectancy, mostly due to physical health conditions that are life-shortening. This clinical review highlights pertinent risk issues for such conditions in Borderline Personality Disorder and suggests ways in which clinicians might address these. Selective literature review. People with Borderline Personality Disorder have a reduced life expectancy of some 20 years, attributable largely to physical health maladies, notably cardiovascular. Risk factors include obesity, sedentary lifestyle, poor diet and smoking. Added to these are other physical health problems, including poor sexual health, self-harm, substance use and blood-borne viruses. Chronic pain and opioid and benzodiazepine use are also common in people with Borderline Personality Disorder. Some psychiatric medications commonly used in people with Borderline Personality Disorder - notably certain antipsychotic agents - can add to the metabolic burden. Barriers to care include self-stigma and erratic adherence to medical care, as well as stigma on the part of clinicians, who often do not screen or provide adequate care for the physical health problems suffered by people with Borderline Personality Disorder. Clinicians need to be aware of the physical health problems in people with Borderline Personality Disorder and ensure appropriate screening and interventions, both preventative and therapeutic, are offered routinely.

Physical health problems in people with psychosis: The issue for informal carers.

Reduced life expectancies are recorded in adults with psychotic disorders. Informal carers play key roles in improving illness outcomes for patients, including significantly reducing rates of relapse and hospitalisation. There is, however, a dearth of literature detailing carers' perspectives on physical health problems in the relatives they care for and implications for those in the caregiving role. The study sought to explore carers' subjective experiences of supporting a relative with psychosis and physical health problems. Carers of adults with psychosis were interviewed individually, or as part of a group, about physical health problems in the relatives they care for. Five key themes were identified from the interviews that reflected (1) ubiquity of physical health problems in psychosis, (2) gaps in service provision for those living with mental and physical health problems, (3) carers' role in responding to service gaps, (4) difficult conversations and (5) impact on carer health. Service initiatives that are designed to improve patient physical health in psychosis should not overlook the role that informal carers might have in supporting this process. The implications that patient physical health problems present for carer well-being and the quality of the caregiving relationship in psychosis deserve further investigation.

Physical health issues in adults with severe or profound intellectual and motor disabilities: a systematic review of cross-sectional studies.

People with severe or profound intellectual and motor disabilities (SPIMD) encounter several risk factors associated with higher mortality rates. They are also likely to experience a cluster of health problems related to the severe brain damage/dysfunction. In order to earlier detect physical health problems in people with SPIMD, first of all, knowledge regarding the prevalence of physical health problems is necessary. The aim of this systematic review was to methodically review cross-sectional studies on the prevalence of various types of physical health problems in adults with SPIMD. MedLine/PubMed, CINAHL, Embase, PsycINFO and Web of Science were searched for studies published between 2004 and 2015. The quality of the incorporated studies was assessed utilising an adjusted 'risk of bias tool' for cross-sectional studies. To estimate the prevalence of the health problems, the proportion and corresponding confidence interval were calculated. A random effect meta-analysis was performed when at least three studies on a specific health problem were available. In total, 20 studies were included and analysed. In the meta-analysis, a homogeneous prevalence rate of 70% (CI 65-75%) was determined for epilepsy. Heterogeneous results were ascertained in the meta-analysis for pulmonary/respiratory problems, hearing problems, dysphagia, reflux disease and visual problems. For the health problems identified in two studies or in a single study, the degree of evidence was low. As expected, higher prevalence rates were found in the current review compared with people with ID for visual problems, epilepsy and spasticity. This review provides an overview of the current state of the art research on the prevalence of health problems in adults with SPIMD. There is a substantial need for comprehensive epidemiological data in order to find clusters of health problems specific for people with SPIMD. This would provide insight into the excess morbidity associated with SPIMD.

Prevalence of reported physical health problems in people with severe or profound intellectual and motor disabilities: a cross‐sectional study of medical records and care plans

People with severe or profound intellectual and motor disabilities (SPIMD) experience numerous serious physical health problems and comorbidities. Knowledge regarding the prevalence of these problems is needed in order to detect and treat them at an early stage. Data concerning these problems in individuals with SPIMD are limited. Therefore, the aim of this study was to determine the prevalence of reported physical health problems in adults with SPIMD through a review of medical records and care plans. We conducted a cross-sectional study employing data obtained from medical and support records. A sample of adults with SPIMD was recruited in eight residential care settings. Physical health problems that had occurred during the previous 12 months or were chronic were recorded. The records of 99 participants were included. A wide range of physical health problems were found with a mean of 12 problems per person. Very high prevalence rates (>50%) were found for constipation, visual impairment, epilepsy, spasticity, deformations, incontinence and reflux. The results suggest that people with SPIMD simultaneously experience numerous, serious physical health problems. The reliance on reported problems may cause an underestimation of the prevalence of health problems with less visible signs and symptoms such as osteoporosis and thyroid dysfunction.

Managing physical health problems in people who inject drugs.

GPs have an important role in addressing the physical health complications of illicit drug use and in particular in people who inject drugs (PWID). Managing these morbidities is within the remit of every GP and does not require any special interest or knowledge.1 A balance will need to be struck between trying to accomplish too much in a single visit and the common problem of arranging adequate follow-up. Skin infections are common in PWID. A study in Glasgow found that 60% of drug injectors reported some kind of skin problems.2 In the Public Health England report Shooting Up , 28% of those injecting psychoactive drugs in 2013 reported that they had experienced an abscess, sore, or open wound during the last year.3 One in 10 PWID are admitted to hospital with a related infection each year and there are frequently delays in seeking healthcare advice. Clinicians should assess common sites of injection such as arms and groin. If there is infection present, then superficial infections without systemic involvement should be treated according to local antibiotic guidelines. Groin infections should be assessed carefully as these can track into deeper structures and may require admission to establish their full extent. It is advised to watch closely for systemic infection. Typical symptoms of tachycardia, hypotension, and reduced capillary refill might, at a glance, be …

Prevention and Treatment of Physical Health Problems in People with Severe Mental Illness From a Patient and Staff Perspective

Introduction Severe mental illness is associated with increased risk of premature death due to chronic somatic diseases. Patients with severe mental illness receive less medical care regarding these problems, than others, and that it is not well defined with whom the responsibility of treating their physical health problems lies. Objectives There is a need for lifestyle interventions and focus on physical health in patients with severe mental illness. The patients' and staff perspective upon the problems and possibilities of change is important. Aims To investigate physical health problems and their causes as well as possibilities for preventing and treating them, as experienced by the staff and patients. Methods Focus Group Discussions with patients and staff respectively, from three out-patient clinics treating patients with schizophrenia or substance use disorder comorbid to another psychiatric disorder. Results The paramount physical health problems are weight issues, cardiovascular diseases and bad physical shape in general. The main causes are lifestyle, the mental disorder and organisational issues. Possibilities for prevention and treatment includes: a case-manger, binding communities with like-minded. Furthermore less fragmentation of the treatment system and implementation of focus upon physical health into daily practice in psychiatry. Conclusions To prevent and treat physical health problems in patients with severe mental illness, support in daily structure and lifestyle changes is needed. There is a need for a change in clinical practice and implementation of routines regarding physical health, supported by the managements.

Assessment and treatment of physical health problems among people with schizophrenia: national cross-sectional study.

In the UK and other high-income countries, life expectancy in people with schizophrenia is 20% lower than in the general population. To examine the quality of assessment and treatment of physical health problems in people with schizophrenia. Method Retrospective audit of records of people with schizophrenia or schizoaffective disorder aged ⩾18. We collected data on nine key aspects of physical health for 5091 patients and combined these with a cross-sectional patient survey. Body mass index was recorded in 2599 (51.1%) patients during the previous 12 months and 1102 (21.6%) had evidence of assessment of all nine key measures. Among those with high blood sugar, there was recorded evidence of 53.5% receiving an appropriate intervention. Among those with dyslipidaemia, this was 19.9%. Despite this, most patients reported that they were satisfied with the physical healthcare they received. Assessment and treatment of common physical health problems in people with schizophrenia falls well below acceptable standards. Cooperation and communication between primary and secondary care services needs to improve if premature mortality in this group is to be reduced.

Psychiatry in the 2000s: fear, risk and the internet

The purpose of this paper is to discuss the experience of psychiatry training in the decade 2000-2010. This period was a time of consolidating previous advances made during the decade of the brain, and one in which world events shaped the focus of policy and clinical care. Terrorist acts and war, and their consequences (people seeking refuge and asylum) contributed to a climate of fear which flowed on to psychiatric practice. Training at this time appeared preoccupied with risk assessment. We became more aware of the complexity of physical health problems in people with mental illness and were taught to prevent and manage them in our patients. During this decade, the internet and mobile technology shaped the way we communicate. For psychiatry, it delivered new ways to enhance mental health literacy, and access to information and on-line therapy and support. Local and world events in the 2000s influenced psychiatric practice and consumer involvement. A focus on risk may have led to more conservative management but also to recognition of the profession's responsibility for the physical health of their patients. The new decade promises even more use of internet technology, a new education program and opportunities for trainees.

P-1245 - Improving the physical health of residents in psychiatric facilities: a randomised control trial

Background Meta-analyses describe increased physical morbidity and increased mortality on account of somatic diseases among residents with psychiatric diseases. We need more knowledge about how to integrate the prevention and care of somatic illness to this group of residents with severe psychiatric illness. Aims To investigate if active awareness on the physical health has an effect on residents' physical health. Method Randomised controlled intervention study with a 12-month follow-up. Results The intervention results in a statistical significance reduction in the unhealthy waist circumference among residents (3.2 cm. p = 0.018). There are improvements in the blood values of cholesterol, LDL, fasting glucose among residents. Conclusions Active awareness on the physical health has a positive effect of the physical health of the residents. There are excess physical health problems in people with severe mental illness. The potential and needs for prevention and treatment are considerably. Declaration of interest None.

Physical Health and Schizophrenia in Clinical Practice Guidelines and Consensus Statements

Research about the epidemiology of physical health problems in schizophrenia, as well as the development of consensus statements and recommendations to deal with it, has increased in recent years. The objective of this study is to identify, review and compare the clinical practice guidelines and consensus statements on physical health problems in people with schizophrenia that have developed over the last five years. We conducted a computerized search in PubMed of the literature regarding the management of schizophrenia. We identified 8 clinical practice guidelines or expert consensus statements, including recommendations for monitoring the physical health of people with schizophrenia. We extracted descriptive information from each article and established the level of consensus between them regarding the physical health parameters that they recommend monitoring. Most of the studies identified were conducted by multidisciplinary groups from European countries between 2010 and 2012. Their recommendations were agreed upon and evidence based and all of them concurred in that the study population is especially vulnerable to physical illness. Although there was a high degree of agreement on most of the physical health parameters that they recommend monitoring, their degree of agreement regarding regular check-ups, including blood tests and renal, hepatic and thyroid function tests, was low. This lack of agreement may be related to the specificity of their approach. There is a need to include all components of physical health as a key part of the management of schizophrenia, which requires comprehensive guidelines and systematic and evidence-based assessments and interventions, but also changes in care professionals’ attitudes, stigma and the organization of health care services.

Diabetes and cardiovascular risk in severe mental illness: a missed opportunity and challenge for the future

AbstractSchizophrenia and bipolar illness are severe mental illnesses that affect around 1–2% of the population. They are associated with premature mortality with a reduced life‐expectancy of 10–20 years. Although suicide and trauma contribute the highest relative risk of mortality, physical illness accounts for around three‐quarters of all deaths, with cardiovascular disease being the most common cause of death. Traditional cardiovascular risk factors including diabetes, dyslipidaemia, obesity and smoking are all more common in people with severe mental illness (SMI).Although there has been an increasing awareness of physical health issues in people with SMI, the level of screening for and management of cardiovascular risk factors has remained low. A number of national and international bodies have developed guidelines to address the challenge of physical morbidity in SMI. The principles of screening for and managing cardiovascular disease in people with SMI are similar to those in the general population, but there are additional challenges. Health care professionals within psychiatry, general practice and medical specialties need to work together to reduce the burden of physical health problems in people with SMI. Copyright © 2010 John Wiley & Sons.