Physical health management below par in schizophrenia patients

By Eleanor McDermid, Senior medwireNews Reporter

The diagnosis and treatment of physical ailments in patients with schizophrenia falls below acceptable standards, shows a national audit of patients in England and Wales.

This may be partly because of confusion as to where responsibility for the physical health of psychiatric patients lies, suggest Mike Crawford (Royal College of Psychiatrists, London, UK) and co-workers.

“During the pilot phase of the audit, it became clear that many trusts did not keep up-to-date records of physical health monitoring and that responsibility for monitoring the health of people with schizophrenia often lay with the patient’s primary care team”, they report in The British Journal of Psychiatry.

The team proposes that responsibility for physical health should lie with secondary healthcare services for 6 months after the initiation of, or major changes to, antipsychotic medication, and with primary care practitioners the rest of the time.

The audit covered 5091 patients, 10.7% of whom were considered to have a physical condition with a moderate or severe impact on their daily activities. The proportion of patients who had checks on key physical health indicators over the previous 12 months ranged from 47.0% for cholesterol levels to 87.3% for smoking status. Just 21.6% had all nine indicators recommended by the UK’s National Institute for Health and Care Excellence recorded.

Among patients who had received checks, between 7.6% (for alcohol consumption) and 50.6% (for smoking) were on record as requiring intervention. The proportion of patients who actually received an intervention was highest for body mass index, alcohol consumption and substance misuse, at 72.0–73.1%, but fell to just 19.9% for cholesterol.

Despite this, 82% of 2323 patients who responded to a user service survey felt that their physical health had been taken seriously, even though not all of these patients recalled receiving a physical health check within the previous 12 months.

“At present it seems that most people with schizophrenia believe that their physical healthcare is being properly attended to, whereas the results of this audit show that it is not”, observe Crawford et al.

They conclude: “Mental health practitioners need to have the knowledge and skills to assess and treat problems associated with use of antipsychotic medication, and cooperation between primary and secondary care services needs to improve if premature mortality among people with schizophrenia is to be reduced.”

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