What should psychiatrists do to improve the physical health of patients with schizophrenia?

Why do people with schizophrenia have a shortened life expectancy?

People with schizophrenia die on average 14·5 years earlier than the general population,¹ mainly because of physical illness, particularly cardiometabolic disease.^2,3 Contributory factors include lifestyle, cardiometabolic risk factors related to the use of some antipsychotics, and substandard levels of healthcare.²

People with schizophrenia receive inadequate healthcare for physical illnesses

Powerful evidence highlighting the inadequate care experienced by patients with schizophrenia who seek medical advice was provided by Charlene Sunkel, Founder and Chief Executive Officer of Global Mental Health Peer Network. She described her own experience consulting a primary care physician for a physical condition. All went well until she was asked about her medication. On finding out that Ms Sunkel was being treated for schizophrenia, the primary care physician took no further interest in her physical symptoms.

Building a consensus to improve cardiometabolic outcomes

A high level of agreement was reached on using antipsychotics with a favorable cardiometabolic profile

To improve the identification and management of cardiometabolic risk among patients with schizophrenia, 115 experts in schizophrenia spectrum disorders (SSD) or in cardiovascular and metabolic diseases in Europe convened to seek a consensus on key statements using a Delphi method,³ explained Professor Armida Mucci, Naples, Italy.

Three key statements on each of the following four topics on cardiometabolic risk among patients with schizophrenia were explored and subjected to Delphi voting:

• Cardiometabolic risk factors
• Cardiometabolic risk factors related to antipsychotic treatment
• Differences in antipsychotics with regards to cardiometabolic profiles
• Management of cardiometabolic risk³

For each statement, experts expressed their level of agreement using a 5-point Likert scale — 1, strongly disagree; 2, disagree; 3, agree; 4, more than agree; 5, strongly agree.

Consensus higher than 85% (i.e., responses 3, 4 and 5) was reached for all statements in the first round.

85% agreement achieved that the psychiatrists should be responsible for managing the cardiometabolic risk

Professor Armida Mucci particularly highlighted the high levels of agreement on the high cardiometabolic risk for patients with SSD (98% agreement) and the importance of lifestyle modification (100% agreement) and treatment of risk factors (98% agreement), including the use of antipsychotics with a favorable cardiometabolic profile (99% agreement).³

In addition, there was an 85% agreement that psychiatrists should take responsibility for the management of the cardiometabolic risk.³

Guidelines to protect the physical health of patients with schizophrenia

Offer patients regular monitoring of their physical health to lower the excess mortality

Guidelines play a key role in protecting the physical health of patients with schizophrenia, said Professor Wolfgang Gaebel, Dusseldorf, Germany, who led the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) Steering Group responsible for the S3 Guideline for Schizophrenia.⁴

He highlighted the following recommendations in the guideline relevant to the physical health of patients with schizophrenia:⁴

Offer regular monitoring and treatment for high blood pressure, abnormal lipid levels, obesity, diabetes or risk of diabetes, smoking, and physical inactivity

• Perform broad differential diagnostic tests and screening for organic causes for every new patient with psychotic symptoms (for patients later in the course of the disease, confirm that these tests have been carried out and, if not, offer these tests)
• Enquire about and evaluate clinical symptoms that indicate typical medical comorbidities
• Offer regular monitoring and treatment for high blood pressure, abnormal lipid levels, obesity, diabetes or risk of diabetes, smoking, or physical inactivity⁴