Vicious Circle of Comorbidity Links Medical, Mental Illness

By Sherman, Carl | Clinical Psychiatry News, October 2005 | Go to article overview

Vicious Circle of Comorbidity Links Medical, Mental Illness


Sherman, Carl, Clinical Psychiatry News


NEW YORK -- Schizophrenia and bipolar disorder pose a triple health threat: The conditions themselves are associated with a higher prevalence of serious medical illness, some drugs used to treat them increase disease risk, and affected individuals are likely to have inadequate medical care, Ilise D. Lombardo, M.D., said at a conference on schizophrenia sponsored by Columbia University.

The unhealthful influence is bidirectional: The psychiatric course tends to be worse in individuals with chronic medical conditions or medical risk factors like obesity. (For example, a survey of 1,379 bipolar patients found that 44% had comorbid medical conditions and linked the presence and severity of medical problems to the severity of the psychiatric disorder.)

"Psychiatrists should monitor risk factors, coordinate care with internists, and involve families in medical issues," said Dr. Lombardo of the university.

Serious mental illness is life-threatening: The rate of mortality from natural causes among patients with bipolar disorder and schizophrenia is double that of the population as a whole; for unipolar depression, the mortality rate is 1.5 times that of the general population. Cardiovascular disease and, to a lesser extent, endocrine disorders are mainly responsible for the higher rates.

This increased mortality is not surprising in light of the high prevalence of cardiovascular risk factors in the psychiatric population, Dr. Lombardo said.

Among patients with schizophrenia, 18% have elevated total cholesterol levels, 20% have hypertension, 75% smoke cigarettes, about 50% are overweight or obese, and 72% are sedentary.

An estimated 30%-60% of schizophrenia patients have metabolic syndrome--a constellation of abdominal obesity, lipid abnormalities, and abnormal glucose metabolism that triples the risk of dying of a myocardial infarction, Dr. Lombardo said at the meeting, which was cosponsored by the New York State Psychiatric Institute.

But although the medical needs of people with severe and persistent mental illness would appear to be greater, they "have less access and less quality medical care," said Dr. …

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