Patients with serious mental illness need to be treated for physical and mental health

CENTRE FOR ADDICTION AND MENTAL HEALTHOct 1 2009

- '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.

Results show that Ontarians who take 'atypical antipsychotics,' which are part of standard therapy, were about 40% more likely to be readmitted to hospital for serious cardiovascular conditions when compared to the appendicitis group. This was true even when smoking and other known risk factors for heart disease were taken into account, says Dr. Callaghan.

The study analyzed Ontario statistics from 2002-2006 on a total of 20,000 patients' admission to the Emergency Room or hospital, based on diagnoses for either schizophrenia or appendicitis. The admission statistics are compiled by the Canadian Institute for Health Information.

The study is "Schizophrenia and the incidence of cardiovascular morbidity: A population-based longitudinal study in Ontario, Canada," published today in Schizophrenia Research.

Similar results for bipolar disorder

In another phase of the same study, analysis of the hospital data found a similar risk pattern for individuals who have bipolar disorder. That research report was published earlier this month in the Journal of Affective Disorders.

"The bottom line is the same. We need to combine primary care with psychiatric care in order to close the gap, treat the whole person, and prevent both psychiatric and cardiovascular risk factors," he says.

The research reports were supported by an institutional grant from the Ontario Ministry of Health and Long-Term Care to the Centre for Addiction and Mental Health.