- 'We need better blood monitoring and primary care' -
New research backs up the demand to integrate psychiatric care with primary care services for people with serious mental disorders in Ontario, according to a study published today. "Patients need their care providers to close that gap," says lead author Dr. Russell Callaghan of the Centre for Addiction and Mental Health (CAMH) in Toronto.
Dr. Callaghan's study shows that people taking some medications for schizophrenia or bipolar disorder are at significantly higher risk of coronary heart disease when compared to the general population.
While physicians and patients have long known that some commonly prescribed medications - called 'atypical antipsychotics' - can cause obesity, metabolic disorders, and diabetes, this is among the first studies to actually quantify patients' increased risks for coronary heart disease, says Dr. Callaghan. Better primary care is the key to preventing and treating the complex health issues involved, he says.
Treat the whole person
"We keep in mind that these drugs save lives. They are part of the standard, effective treatment for people who are at risk of suicide and other causes of death associated with serious mental illness," cautions Dr. Callaghan.
Adds Dr. Tony Cohn, lead psychiatrist at the Mental Health and Metabolism Clinic at CAMH: "This study underscores the importance of attending to the physical as well as the mental health of patients with serious mental illness. Patients should be screened regularly for diabetes, high blood pressure, and increased cholesterol. That's why our primary health care system should work closely with our mental health system."
Although the risk of other causes of death (such as suicide) may be greater than that of cardiac death for most patients, addressing the cardiovascular issues is critically important, says Dr. Callaghan. Higher rates of obesity and cardiac risk factors can be a barrier for patients in adhering to their medication regimens. "That is one reason why medication guidelines, clinical guidelines, and policies from the federal and provincial governments all say that we need to treat the whole person," he adds.
Comparing hospital readmission rates
Dr. Callaghan's study compared Emergency Department or hospital admission rates based on a diagnosis of schizophrenia to similar admission rates based on a diagnosis of appendicitis. The study used these figures as a baseline, and compared them to rates of readmission for severe cardiovascular conditions, such as heart attack and high blood pressure - up to four years after the initial admission to the emergency department or hospital.