Physical health in schizophrenia
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People with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social wit ...
are at a higher than average risk of physical ill
health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
, and earlier death than the general population. The fatal conditions include
cardiovascular The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
,
respiratory The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies gre ...
and metabolic disorders. Although
death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
by suicide in schizophrenia has received much needed attention, and is the leading cause of death among males, death from cardiovascular disease is more common in females, accounting for up to 75 percent of deaths. The causes of physical health problems include factors associated with mental illness and its treatment, poverty, poor housing, higher rates of smoking, poor
diet Diet may refer to: Food * Diet (nutrition), the sum of the food consumed by an organism or group * Dieting, the deliberate selection of food to control body weight or nutrient intake ** Diet food, foods that aid in creating a diet for weight loss ...
and lack of exercise.


Dynamics

Despite the high rates of physical health problems, mental health service users report that
health care worker A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...
s overlook their physical health needs. Service users would like mental health practitioners to do more for their physical health. Rethink interviewed 2,998 mental health service users, over half of whom lived with a diagnosed severe mental illness. Nearly one third said regular physical health checks were in their top three priorities for improving services. Mental health practitioners may feel unable to provide physical health input. Also there may be a feeling that people with mental health problems will not be interested in physical health education and support. In fact, much health promotion is simple and well received by service users. One review showed that people with schizophrenia benefited from a variety of behavioural interventions and achieved
weight loss Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat ( adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other co ...
and
lifestyle Lifestyle often refers to: * Lifestyle (sociology), the way a person lives * ''Otium'', ancient Roman concept of a lifestyle * Style of life (german: Lebensstil, link=no), dealing with the dynamics of personality Lifestyle may also refer to: Bu ...
change. Schizophrenia also affects the attendance to
cancer screening Cancer screening aims to detect cancer before symptoms appear. This may involve blood tests, urine tests, DNA tests, other tests, or medical imaging. The benefits of screening in terms of cancer prevention, early detection and subsequent treatment ...
which is seen as one of the factors leading to shorter life expectancy. For example, women with schizophrenia are half as likely to attend
breast cancer screening Breast cancer screening is the medical screening of asymptomatic, apparently healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening test ...
compared to the general population. Another study found little evidence to support one intervention over another, but argued that moderately strenuous exercise was important.


Health policy

Many guidelines reflect the need to incorporate physical health care into mental health provision, including NICE in the UK. In primary care, the prodigy website provides practical and accessible advice. However, a review of international guidelines for physical wellbeing in SMI has found that recommendations are variable. UK guidelines failed to address the specifics of physical health monitoring and lifestyle intervention, while
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
guidelines were more descriptive. Field studies suggested that all guidelines were inadequately implemented in practice. The DoH in the UK has recommended wide-ranging action to enable the general population to choose healthier lifestyles in the ''Choosing Health''
white paper A white paper is a report or guide that informs readers concisely about a complex issue and presents the issuing body's philosophy on the matter. It is meant to help readers understand an issue, solve a problem, or make a decision. A white pape ...
. In the UK the
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS) is deeply split along physical/mental lines. Instead of treating whole people, services tend to treat parts of people separately. The commissioning framework to support the physical health needs of people with severe mental illness recommends a holistic approach with interagency collaboration.


Medication

The current medical view is that all people with schizophrenia must take medications for the disorder. These
antipsychotic Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of ...
medications have
adverse effects An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complica ...
such as weight gain and induce feelings of fatigue that inhibit physical activity. The request for the people with schizophrenia to exercise for cardiovascular health then take medications (originally named "major tranquilizers") that inhibit activity is a
double bind A double bind is a dilemma in communication in which an individual (or group) receives two or more reciprocally conflicting messages. In some scenarios (e.g. within families or romantic relationships) this can be emotionally distressing, creatin ...
.


See also

* Schizophrenia and smoking


References

{{reflist Schizophrenia