Physical health of the severe and enduring mentally ill
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Physical Health of the Severe and Enduring Mentally Ill. Add your name here And title?. The Evidence?. Few papers Most studies are by psychiatrists, about inpatient populations There are some large epidemiological studies which look at co-morbidity

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The evidence l.jpg
The Evidence?

  • Few papers

  • Most studies are by psychiatrists, about inpatient populations

  • There are some large epidemiological studies which look at co-morbidity

  • There are no papers on the characteristics (physical or mental) of the SMI not in contact with the secondary services


Characteristics l.jpg
Characteristics

  • In a study* of 101 patients in the community

    • 26 were obese (BMI > 30)

    • 53 were current smokers

    • 11 were hypertensive (BP systolic >160, diastolic >100)

  • SMR 150 (all causes)**

    *Kendrick 1996 B J Psych

    **Harris and Barraclough 1998 B J Psych


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SMR by cause of death

  • Respiratory disease

    • SMR 250

  • Infectious disease

    • SMR 500

  • Cardiovascular disease

    • SMR 250


Characteristics health promotion l.jpg
Characteristics - Health Promotion

  • Consultation rate 13 -14*

  • Data that is recorded

    • smoking 23%

    • BP 38%

    • Cx smear 28%

    • Mammography 8%

    • Alcohol use 20%

    • Weight 27%

    • Cholesterol 2.5%

      *Burns and Cohen BJGP 1998


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Schizophrenia co-morbidity

  • Cardiovascular disease - lifestyle

  • Respiratory disease - lifestyle

  • Diabetes - lifestyle, medication

  • Rheumatoid Arthritis - ??

  • Drug related movement disorders - iatrogenic


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Bi-polar co-morbidity

  • Cardiovascular disease - lifestyle

  • Respiratory disease - lifestyle

  • Diabetes - lifestyle

  • Drug related movement disorders - iatrogenic

  • Drug related thyroid and renal disorder - lithium


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What to do?

  • Burns and Kendrick* recommend

    • “A proactive approach, closed questions for physical symptoms, and regular screening”

    • Examine BP, chest, skin, side effects and urine analysis

    • Investigations: CXR, ECG, FBC, ESR, TFTs

    • Vision and hearing tests

      *Psychiatry and General Practice Today 1994 (RCGP/RCPsych)


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(More) What to do?

  • GP Guide from the Institute of Psychiatry

    • BP, IHD, cerebrovascular disease

    • Chronic bronchitis, infections

    • Obesity

    • Chiropody, vision and hearing problems

    • Diabetes mellitus, thyroid disease

    • Drug side effects

    • Family planning including cervical smears

    • Smoking, alcohol, exercise


What now l.jpg
What now?

  • People with SMI have physical health needs that are poorly understood

  • There is a dearth of good literature/ evidence on effective interventions

  • There is a dearth of service development processes for the physical health of the SMI


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What can be done?

  • Local development schemes to address the physical health of those with a severe mental illness

  • Ensure that every person with a severe mental illness has their blood pressure, and urine analysis checked annually, and is offered protection against influenza


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Who are the SMI?

Definitions vary but:

  • People with psychosis

  • Schizophrenia

  • Bi-polar affective disorder

    Probably not:

  • Personality disorder

  • Severe depression


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How can they be identified?

Develop a register by:

  • Searching by diagnosis

  • Searching by therapeutic category

  • Asking the Primary Health Care Team

  • Asking the Community Mental Health Team


And then l.jpg
And then?

  • Call and recall system as for other “at risk” groups

  • Meet regularly with the CMHT attached to the practice

  • Regular review/audit of care that is being provided



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