Skip to main content
SpringerLink
Log in

Medical Morbidity and Mortality

  • Chapter
  • First Online:
Psychotic Disorders

Part of the book series: Current Clinical Psychiatry ((CCPSY))

  • 1620 Accesses

Abstract

Psychiatrists are instrumental in improving the medical care that patients with schizophrenia receive. Given the mortality gap between patients with schizophrenia and their peers, this is not an academic issue, and a medical prevention mind-set is needed. In this chapter, I review what psychiatrists can do to prevent medical diseases, particularly cardiovascular disease. Guideline-concordant metabolic monitoring is one specific task that falls onto our shoulders. Taking on a leadership role to reduce substandard care will require reverse care integration (bringing medical care to psychiatric patients) and novel models of care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wikipedia. Mens sano in corpore sano. Available from: https://en.wikipedia.org/wiki/Mens_sana_in_corpore_sano. Accessed on 7/1/2019.

  2. Crump C, Winkleby MA, Sundquist K, Sundquist J. Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. Am J Psychiatry. 2013;170:324–33.

    Article  PubMed  Google Scholar 

  3. Ringen PA, Engh JA, Birkenaes AB, Dieset I, Andreassen OA. Increased mortality in schizophrenia due to cardiovascular disease – a non-systematic review of epidemiology, possible causes, and interventions. Front Psych. 2014;5:137.

    Google Scholar 

  4. Tanskanen A, Tiihonen J, Taipale H. Mortality in schizophrenia: 30-year nationwide follow-up study. Acta Psychiatr Scand. 2018;138:492–9.

    Article  CAS  PubMed  Google Scholar 

  5. Frieden TR. Shattuck lecture: the future of public health. N Engl J Med. 2015;373:1748–54.

    Article  CAS  PubMed  Google Scholar 

  6. Torniainen M, Mittendorfer-Rutz E, Tanskanen A, Bjorkenstam C, Suvisaari J, Alexanderson K, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophr Bull. 2015;41:656–63.

    Article  PubMed  Google Scholar 

  7. Kolappa K, Henderson DC, Kishore SP. No physical health without mental health: lessons unlearned? Bull World Health Organ. 2013;91:3–3A.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry. 2015;72:1172–81.

    Article  PubMed  Google Scholar 

  9. Irwin KE, Henderson DC, Knight HP, Pirl WF. Cancer care for individuals with schizophrenia. Cancer. 2014;120:323–34.

    Article  PubMed  Google Scholar 

  10. Irwin KE, Park ER, Shin JA, Fields LE, Jacobs JM, Greer JA, et al. Predictors of disruptions in breast cancer care for individuals with schizophrenia. Oncologist. 2017;22:1374–82.

    Article  PubMed  PubMed Central  Google Scholar 

  11. de Hert M, Schreurs V, Vancampfort D, van Winkel R. Metabolic syndrome in people with schizophrenia: a review. World Psychiatry. 2009;8:15–22.

    Article  Google Scholar 

  12. Goff DC, Sullivan LM, McEvoy JP, Meyer JM, Nasrallah HA, Daumit GL, et al. A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophr Res. 2005;80:45–53.

    Article  PubMed  Google Scholar 

  13. Correll CU, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA, et al. Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study. JAMA Psychiatry. 2014;71:1350–63.

    Article  PubMed  Google Scholar 

  14. American Psychiatric Association. Position statement on the role of psychiatrists in reducing physical health disparities in patients with mental illness. 2015. Available from: https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2015-Role-of-Psychiatrists-in-Reducing-Physical-Health-Disparities-in-Patients-with-Mental-Illness.pdf. Accessed on 7/1/2019.

  15. Vanderlip ER, Raney LE, Druss BG. A framework for extending psychiatrists’ roles in treating general health conditions. Am J Psychiatry. 2016;173:658–63.

    Article  PubMed  Google Scholar 

  16. Kugathasan P, Horsdal HT, Aagaard J, Jensen SE, Laursen TM, Nielsen RE. Association of secondary preventive cardiovascular treatment after myocardial infarction with mortality among patients with schizophrenia. JAMA Psychiatry. 2018;75:1234–40.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Druss BG. Can better cardiovascular care close the mortality gap for people with schizophrenia? JAMA Psychiatry. 2018;75:1215–6.

    Article  PubMed  Google Scholar 

  18. Goff DC, Cather C, Evins AE, Henderson DC, Freudenreich O, Copeland PM, et al. Medical morbidity and mortality in schizophrenia: guidelines for psychiatrists. J Clin Psychiatry. 2005;66:183–94.

    Article  PubMed  Google Scholar 

  19. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52:793–800.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chasser Y, Kim AY, Freudenreich O. Hepatitis C treatment: clinical issues for psychiatrists in the post-interferon era. Psychosomatics. 2017;58:1–10.

    Article  PubMed  Google Scholar 

  21. MacLaurin SA, Henderson DC, Freudenreich O. Delineating responsibility: primary care provider perspective. Psychiatr Serv. 2015;66:333.

    Article  PubMed  Google Scholar 

  22. Musil R, Obermeier M, Russ P, Hamerle M. Weight gain and antipsychotics: a drug safety review. Expert Opin Drug Saf. 2015;14:73–96.

    Article  CAS  PubMed  Google Scholar 

  23. Tek C, Kucukgoncu S, Guloksuz S, Woods SW, Srihari VH, Annamalai A. Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications. Early Interv Psychiatry. 2016;10:193–202.

    Article  PubMed  Google Scholar 

  24. Bak M, Fransen A, Janssen J, van Os J, Drukker M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One. 2014;9:e94112.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kane JM, Skuban A, Hobart M, Ouyang J, Weiller E, Weiss C, et al. Overview of short- and long-term tolerability and safety of brexpiprazole in patients with schizophrenia. Schizophr Res. 2016;174:93–8.

    Article  PubMed  Google Scholar 

  26. Durgam S, Greenberg WM, Li D, Lu K, Laszlovszky I, Nemeth G, et al. Safety and tolerability of cariprazine in the long-term treatment of schizophrenia: results from a 48-week, single-arm, open-label extension study. Psychopharmacology. 2017;234:199–209.

    Article  CAS  PubMed  Google Scholar 

  27. Meyer JM, Mao Y, Pikalov A, Cucchiaro J, Loebel A. Weight change during long-term treatment with lurasidone: pooled analysis of studies in patients with schizophrenia. Int Clin Psychopharmacol. 2015;30:342–50.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Buchanan RW, Kreyenbuhl J, Kelly DL, Noel JM, Boggs DL, Fischer BA, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull. 2010;36:71–93.

    Article  PubMed  Google Scholar 

  29. Fitzgerald FT. The tyranny of health. N Engl J Med. 1994;331:196–8.

    Article  CAS  PubMed  Google Scholar 

  30. Bartels SJ. Can behavioral health organizations change health behaviors? The STRIDE study and lifestyle interventions for obesity in serious mental illness. Am J Psychiatry. 2015;172:9–11.

    Article  PubMed  Google Scholar 

  31. Green CA, Yarborough BJ, Leo MC, Yarborough MT, Stumbo SP, Janoff SL, et al. The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial. Am J Psychiatry. 2015;172:71–81.

    Article  PubMed  Google Scholar 

  32. Ward MC, White DT, Druss BG. A meta-review of lifestyle interventions for cardiovascular risk factors in the general medical population: lessons for individuals with serious mental illness. J Clin Psychiatry. 2015;76:e477–86.

    Article  PubMed  Google Scholar 

  33. Song Z, Baicker K. Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial. JAMA. 2019;321:1491–501.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Speyer H, Christian Brix Norgaard H, Birk M, Karlsen M, Storch Jakobsen A, Pedersen K, et al. The CHANGE trial: no superiority of lifestyle coaching plus care coordination plus treatment as usual compared to treatment as usual alone in reducing risk of cardiovascular disease in adults with schizophrenia spectrum disorders and abdominal obesity. World Psychiatry. 2016;15:155–65.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tufekci Z. Quantified self. Sci Am. 2019;320:85.

    Google Scholar 

  36. Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2017;43:546–56.

    Article  PubMed  Google Scholar 

  37. Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45:1343–61.

    Article  CAS  PubMed  Google Scholar 

  38. American Diabetes Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27:596–601.

    Article  Google Scholar 

  39. Morrato EH, Newcomer JW, Kamat S, Baser O, Harnett J, Cuffel B. Metabolic screening after the American Diabetes Association’s consensus statement on antipsychotic drugs and diabetes. Diabetes Care. 2009;32:1037–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Morrato EH, Campagna EJ, Brewer SE, Dickinson LM, Thomas DS, Miller BF, et al. Metabolic testing for adults in a state Medicaid program receiving antipsychotics: remaining barriers to achieving population health prevention goals. JAMA Psychiatry. 2016;73:721–30.

    Article  PubMed  Google Scholar 

  41. Tomasik J, Lago SG, Vazquez-Bourgon J, Papiol S, Suarez-Pinilla P, Crespo-Facorro B, et al. Association of insulin resistance with schizophrenia polygenic risk score and response to antipsychotic treatment. JAMA Psychiatry. 2019 (in press).

    Google Scholar 

  42. Wiechers IR, Viron M, Stoklosa J, Freudenreich O, Henderson DC, Weiss A. Impact of a metabolic screening bundle on rates of screening for metabolic syndrome in a psychiatry resident outpatient clinic. Acad Psychiatry. 2012;36:118–21.

    Article  PubMed  Google Scholar 

  43. Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161:1334–49.

    Article  PubMed  Google Scholar 

  44. NICE. Psychosis and schizophrenia in adults: prevention and management. 2014. Available from: https://www.nice.org.uk/guidance/cg178. Accessed on 7/1/2019.

  45. Grimes DA, Schulz KF. Uses and abuses of screening tests. Lancet. 2002;359:881–4.

    Article  PubMed  Google Scholar 

  46. Larsen JR, Vedtofte L, Jakobsen MSL, Jespersen HR, Jakobsen MI, Svensson CK, et al. Effect of liraglutide treatment on prediabetes and overweight or obesity in clozapine- or olanzapine-treated patients with schizophrenia spectrum disorder: a randomized clinical trial. JAMA Psychiatry. 2017;74:719–28.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Martin WF, Correll CU, Weiden PJ, Jiang Y, Pathak S, DiPetrillo L, et al. Mitigation of olanzapine-induced weight gain with samidorphan, an opioid antagonist: a randomized double-blind phase 2 study in patients with schizophrenia. Am J Psychiatry. 2019;176:457–67.

    Article  PubMed  Google Scholar 

  48. Gerken AT, Baggett TP, Freudenreich O. Consider Rx metformin to prevent metabolic syndrome [Pearls series]. Curr Psychiatr Ther. 2016;15:e1–2.

    Google Scholar 

  49. Zheng W, Li XB, Tang YL, Xiang YQ, Wang CY, de Leon J. Metformin for weight gain and metabolic abnormalities associated with antipsychotic treatment: meta-analysis of randomized placebo-controlled trials. J Clin Psychopharmacol. 2015;35:499–509.

    Article  CAS  PubMed  Google Scholar 

  50. Stroup TS, McEvoy JP, Ring KD, Hamer RH, LaVange LM, Swartz MS, et al. A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP). Am J Psychiatry. 2011;168:947–56.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315:2424–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Zheng W, Wang S, Ungvari GS, Ng CH, Yang XH, Gu YH, et al. Amantadine for antipsychotic-related weight gain: meta-analysis of randomized placebo-controlled trials. J Clin Psychopharmacol. 2017;37:341–6.

    Article  CAS  PubMed  Google Scholar 

  53. Correll CU, Maayan L, Kane J, Hert MD, Cohen D. Efficacy for psychopathology and body weight and safety of topiramate-antipsychotic cotreatment in patients with schizophrenia spectrum disorders: results rrom a meta-analysis of randomized controlled trials. J Clin Psychiatry. 2016;77:e746–56.

    Article  PubMed  Google Scholar 

  54. Wikipedia. Citizenship in a Republic. Available from: https://en.wikipedia.org/wiki/Citizenship_in_a_Republic. Accessed on 7/1/2019.

  55. Nasrallah HA, Harvey PD, Casey D, Csoboth CT, Hudson JI, Julian L, et al. The Management of Schizophrenia in Clinical Practice (MOSAIC) Registry: a focus on patients, caregivers, illness severity, functional status, disease burden and healthcare utilization. Schizophr Res. 2015;166:69–79.

    Article  PubMed  Google Scholar 

  56. Esswein SA, Druss B. Chapter 8: Integrating care in the public sector. In: Summergrad P, Kathol RG, editors. Integrated care in psychiatry: redefining the role of mental health professionals in the medical setting. Heidelberg: Springer; 2014. p. 127–41.

    Google Scholar 

  57. MacLaurin SA, Vincenzi B, Donahue L, Marcri B, Namey LB, Brent B, et al. CHAMPioning guideline concordant care in a clozapine clinic: applying prevention principles to a high risk cohort. Poster presented at Institute on Psychiatric Services; Washington, DC. October 6–9, 2016.

    Google Scholar 

  58. Rosenberg S, Brunette M, Oxman T, Marsh B, Dietrich A, Mueser K, et al. The STIRR model of best practices for blood-borne diseases among clients with serious mental illness. Psychiatr Serv. 2004;55:660–4.

    Article  PubMed  Google Scholar 

  59. Irwin KE, Park ER, Fields LE, Corveleyn AE, Greer JA, Perez GK, et al. Bridge: person-centered collaborative care for patients with serious mental illness and cancer. Oncologist. 2019; (in press).

    Google Scholar 

  60. Silverman BC, Kim AY, Freudenreich O. Interferon-induced psychosis as a “psychiatric contraindication” to hepatitis C treatment: a review and case-based discussion. Psychosomatics. 2010;51:1–7.

    CAS  PubMed  Google Scholar 

  61. Herold S, Freudenreich O. Hepatitis C virus and schizophrenia: expanding the role of the community psychiatrist. Psychosomatics. 2016;57:634–7.

    Article  PubMed  Google Scholar 

  62. Freudenreich O, Gandhi RT, Walsh JP, Henderson DC, Goff DC. Hepatitis C in schizophrenia: screening experience in a community-dwelling clozapine cohort. Psychosomatics. 2007;48:405–11.

    Article  PubMed  Google Scholar 

  63. Ilyas A, Chesney E, Patel R. Improving life expectancy in people with serious mental illness: should we place more emphasis on primary prevention? Br J Psychiatry. 2017;211:194–7.

    Article  PubMed  PubMed Central  Google Scholar 

Additional Resources

    Web Sites

    Articles

    • Fitzgerald FT. The tyranny of health. N Engl J Med. 1994;331:196–8. – Mandatory reading so you do not become a health zealot.

      Article  CAS  PubMed  Google Scholar 

    • Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161:1334–49. – Important consensus guidelines on health monitoring. While over a decade old, people still refer to them as the fundamental principles are as current as they were in 2004.

      Article  PubMed  Google Scholar 

    • Irwin KE, Freudenreich O, Peppercorn J, Taghian AG, Freer PE, Gudewicz TM. Case records of the Massachusetts General Hospital. Case 30–2016. A 63-Year-old woman with bipolar disorder, cancer, and worsening depression. N Engl J Med. 2016;375:1270–81. – A case discussion that illustrate the complexity of providing optimal cancer care (breast cancer in this case) if there is poorly controlled psychiatric illness.

      Article  PubMed  Google Scholar 

    Download references

    Author information

    Authors and Affiliations

    1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

      Oliver Freudenreich

    Authors
    1. Oliver Freudenreich
      View author publications

      You can also search for this author in PubMed Google Scholar

    Rights and permissions

    Reprints and permissions

    Copyright information

    © 2020 Springer Nature Switzerland AG

    About this chapter

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this chapter

    Freudenreich, O. (2020). Medical Morbidity and Mortality. In: Psychotic Disorders. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-29450-2_25

    Download citation

    • DOI: https://doi.org/10.1007/978-3-030-29450-2_25

    • Published:

    • Publisher Name: Humana, Cham

    • Print ISBN: 978-3-030-29449-6

    • Online ISBN: 978-3-030-29450-2

    • eBook Packages: MedicineMedicine (R0)

    Publish with us

    Policies and ethics

    Search

    Navigation