Taking a holistic view

Two leading European mental health organisations have called for action to address the increasing physical ill health, in particular chronic heart disease, affecting patients with schizophrenia and bipolar disorder.

The call from the Global Alliance of Mental Illness Advocacy Networks (GAMIAN-Europe) and the European Federation of Associations of Families of People with Mental Illness (EUFAMI) follows the results of one of the largest ever global patient and carer surveys in psychiatry, Understanding patients' Needs, Interactions, Treatment & Expectations (UNITE), supported by Pfizer, which revealed that almost 75 per cent of people with schizophrenia and biopolar disorder surveyed reported significant weight gain since being diagnosed with their mental illness.

Some 50 per cent respondents also said that in addition to an increase in weight, they suffered from other health complications, including a rise in cholesterol levels, diabetes and high blood pressure.

ìThis is the first time that the patient voice has been heard with regard to this issue,î said Rodney Elgie, past president of GAMIAN-Europe. ìWe hope that the survey will raise awareness among physicians of the importance of treating the patient holistically. It is no longer acceptable to maintain an artificial division of above and below the neck when considering the treatment of a patient with severe mental illness,î he added.

There is growing evidence that the risks of cardiovascular disease, diabetes and death in this patient group are increased significantly through the use of antipsychotic drugs. However, while the link between antipsychotics and these risks has been acknowledged for a number of years and addressed in treatment guidelines, the survey results revealed that daily prescribing practices are vastly different.

Dr Marc de Hert, clinical psychiatrist and psychotherapist at the University Psychiatric Centre, Katholieke Universiteit, in Belgium, said: ìThe research to support the increase in metabolic complications in these populations has been there for years, there is an increased prevalence of obesity, dislipidaemia and glucose abnormalities in people with severe mental illness and this results in a greatly increased risk of cardiovascular disease.î

A minority of respondents said they received adequate physical health check ups; less than a third of patients with schizophrenia and bipolar in Europe have their blood pressure checked, while just 25 per cent reported being weighed regularly.

Around 40 per cent of people with schizophrenia and 30 per cent of those with bipolar disorder said they gained more weight than they deemed acceptable to continue taking their treatment.

Kevin Jones, secretary general at EUFAMI, said that the treatment of physical disease affecting patients with severe mental illness needed to be addressed urgently, to ensure that suffers get the best level of overall care.

Both GAMIAN-Europe and EUFAMI, along with leading psychiatrists, hope that the results from the UNITE survey will help in raising awareness of the metabolic-related co-morbidities in people with schizophrenia and bipolar disorder.