Forums » Open clinical » General clinical » Did you know people with schizophrenia die so much earlier than other people?
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Did you know people with schizophrenia die so much earlier than other people?
posted at 22/2/2012 11:34 AM GMT
on bmj.com
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*Moderator*
Posts: 597
First: 17/11/2008 Last: 18/5/2012 |
I am sitting in a BMJ meeting that's looking at how we cover multiple co morbidities. Which can seem an impossible task until a psychiatrist in the room told us that men with schizophrenia die 20 years earlier than other men in the UK.. They don't die from suicide (it is a marginal cause for the increase) but from smoking, obesity and cardiovascualr disease as a result of these increased risk factors and also because they can't access health services and when they do there is evidence they don't get the same i.e. the right drugs that other people do when they come in with MIs. Care is still arranged in disease specific teams at least in most places in Britain. So patients with multiple co morbidities may slip through the net. Anyone know any different? |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 22/2/2012 12:01 PM GMT
on bmj.com
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Posts: 28
First: 20/2/2012 Last: 3/4/2012 |
Not too uncommonly I have seen patients following the general take who suffer an underlying mental illness but have presented with a medical problem and have been sent in by their mental health nurse/ from the psych unit. I think the care they receive is different to those without mental illness in some respects. A lot of this is down to the inexperience of the treating physician with mental illness. I don't believe I've ever encountered a situation where the patient has been denied medication or offered alternative medication following an obvious MI or any other barn-door pathologies. Remember in hospital, we are quick to diagnose, label and treat, medically. But our approach to the patient is probably different. In taking histories we might treat the patient as an unreliable historian without justification. This often leads to overinvestigation if anything. I suppose this might be rectified if there were more lines of communication between the psychiatrists/mental health nurses and treating physicians, but sadly as is often the case once the patient is in hospital the lines of communication shut down. |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 22/2/2012 12:30 PM GMT
on bmj.com
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Posts: 371
First: 13/4/2011 Last: 21/5/2012 |
Hello Fellows: In my Hypertension and Diabetes ambulatory clinic, I attend many psychiatric patients with the diagnosis of bipolar disease and schizophrenia. They usually come in with polypharmacy of psychiatric pills. A large amount have resistant hypertension, obesity, overweight, the metabolic syndrome, and need one more drug beyond Metformin for their diabetes control. I think the psychiatrists shoud be more aware and involved with this global epidemics related to the above diseases and also treat or help preventing these diseases, and not just referring this kind of patients to GPs or Specialists. All Best, Joey
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 22/2/2012 4:38 PM GMT
on bmj.com
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Posts: 28
First: 20/2/2012 Last: 3/4/2012 |
That was the general consensus from this meeting actually; that specialists that deal with psychiatric illnesses should also know how to deal with the comorbidities that their patients typically suffer from, the same point was applied to HIV medicine, Renal medicine (happens already, to be fair), At least this way we can minimise the number of referrals, extra clinic appointments for patients and maintain continuity. |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 22/2/2012 6:46 PM GMT
on bmj.com
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Posts: 152
First: 17/12/2011 Last: 20/5/2012 |
As an Inner City GP, I know that my patients who have schizophreinia die earlier that those without schizophrenia. My last hospital job for a year was in psychiatry before starting in General Practice and at the time that I started taking on patients in 1980 [list size 3000, now 9000] the large Mental Hospitals were closing and 'care in the Community ' , started. I think that the trouble with 'care in the Community' is that by and large the Community does not care. So I took on lots of patients with chronic schizophrenia. Anti psychotic drugs, be they the older antipsychotic medications or the 'newer' atypical antipsychotic medications, all have side effect. They tend to increase appetite and produce weight gain. patients with chronic psychoses tend to be poor and live in Inner City areas, their diet tends to be poor . They tend to lack motivation to change. They tend to lack exercise. They tend to smoke and they tend to get type 2 diabetes. So I think that while antipsychotic drugs do work I think that they do increase morbidity and mortality. |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 23/2/2012 8:43 AM GMT
on bmj.com
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Posts: 683
First: 19/4/2010 Last: 17/5/2012 |
COPD is massively underdiagnosed in the psychiatric population. They're note even screened for it. This is not helped by the fact that they can't do spirometry. Mrs Dr DundeeChest presented data at the RCGP annual meeting a year back to show that a general psychiatric ward population simply can't do spirometry - an essential test to fomulate the diagnosis of COPD..... Valentine Poem: Roses are red Violets are blue I have a schizoid personality disorder And so do I |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 23/2/2012 9:27 AM GMT
on bmj.com
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Posts: 24
First: 19/1/2012 Last: 18/4/2012 |
Glad this is being discussed in the 'general clinical' forum, totally agree it's a very important for research and personal professional development/training. For any psychiatrists out there the RCPsych do a great update-your-medical-skills training day in the UK: http://www.rcpsych.ac.uk/training/cetchome.aspx The British Association of Psychopharmacology masterclasses are also fantastic: http://www.bap.org.uk/education.php There is a great review on this at: http://apt.rcpsych.org/content/11/2/125.full Ref: Connolly M, Kelly C. Lifestyle and physical health in schizophrenia. APT 2005, 11:125-13
PS - to Dundee chest - I think the diagnosis you are after is Dissociative identity disorder (where "two or more distinct identities or personality states...that recurrently take control of behavior" according to the DSM-IV). In schizoid personality disorder there is an indifference to emotional intimacy with others, an aloof, detached appearance and social isolation. |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 23/2/2012 11:18 AM GMT
on bmj.com
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Posts: 2075
First: 10/3/2009 Last: 18/5/2012 |
Life style issues eg living in boarding houses etc, poor dietary choices, limited ability to cook for themselves. Throw in psychiatric medications commonly causing sedation and hypothalamic side-effects and we have obesity. Sleep disorders are almost universal in these patients eg insomnia etc etc and obstructve sleep apnoea follows causing more weight gain, and a vicious circle with other comorbidities thrown in and untreated sleep apnoea causing more cognitive impairment, lethargy and obesity. Circadian disorders are also common.
Many of these patients are not good candidates for more conventional treatments of sleep apnoea (eg CPAP) and then they enter a downward spiral. The unfortunate thing is that not enough doctors think of sleep pathology let alone obstructive sleep apnoea in these patients. A similar scenario is seen in Parkinson's. |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 25/2/2012 1:49 PM GMT
on bmj.com
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Posts: 10
First: 24/9/2009 Last: 11/4/2012 |
Smoking is a significant issue because it is currently the only delivery system for nicotine sufficient to have a beneficial effect on muscarinic receptors, no current medication effectively targets. Heavy smoking improves our patients' thought processes; but it is also a risk factor for COPD and other life-shortening disorders. |
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Re: Did you know people with schizophrenia die so much earlier than other people?
posted at 26/2/2012 1:28 AM GMT
on bmj.com
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Posts: 371
First: 13/4/2011 Last: 21/5/2012 |
Smoking, Obesity, Sleep Apnoea, heavy and chronic utilization of non-evidence based psychiatric drugs. All Reversible Risk Factors. Why nobody cares about it in those invidivduals??? Perhaps if we should follow the money, some clues would show-up. All Best, Joey
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Forums » Open clinical » General clinical » Did you know people with schizophrenia die so much earlier than other people?
