Connect 17.10.07

1. Connect 17.10.07 Simon Belderbos Consultant Psychiatrist

3. Dr Henry Maudsley 1835-1918 ‘Diabetes is a disease which often shows itself in families in which insanity prevails’

4. Physical health status of patients with schizophrenia • Life expectancy: 20% shorter than general population2 • Average age of death 61 vs. 76 years • Mortality from circulatory, respiratory, digestive and genitourinary diseases greater than expected2 • Suicide a contributor to mortality2 • 50% patients with Schizophrenia have ‘metabolic syndrome’ • Patients with schizophrenia have a markedly decreased life expectancy due mainly to increased risks of cardiovascular disease (CVD)3 1. Harris & Barraclough. Br J Psychiatry 1998;173:11–53. 2. Newman & Bland. Can J Psychiatry 1991;36:239–45. 3. Casey et al. J Clin Psychiatry 2004;65(suppl 7):4-18.

5. National Database Analysis: prevalence of physical health conditions amongst patients with mental illness Higher rates of ischaemic heart disease, stroke, high blood pressure and diabetes are seen among people with schizophrenia or bipolar disorder compared with the rest of the population People with schizophrenia People with bipolar disorder People without schizophrenia or bipolar disorder Percentage The results of the national data analysis covering England and Wales Hippisley-Cox J and Pringle M (2005) Health inequalities experienced by people with schizophrenia and manic depression: analysis of general practice data in England and Wales. Disability Rights Commission. Equal treatment: closing the gap, July 2006

6. Physical health-related mortality in people with schizophrenia Five-year survival rates are lower for people with schizophrenia than for the rest of the population Percentage of deaths* *after 5 years and adjusted for age 1. Disability Rights Commission. Equal treatment: closing the gap, July 2006

7. ‘Triple Whammy’ • An inherent risk of cardiovascular and metabolic abnormalities resulting from ‘schizophrenia’ itself1,2 • Lifestyle factors • e.g. sedentary life, inadequate diet, smoking, reduced health seeking behaviour. • Treatment2,3 1. Ryan et al. Am J Psychiatry 2003;160:284-9.2. De Hert et al. Clin Pract Epidemiol Mental Health 2006;2:14. 3. Newcomer & Haupt. Can J Psychiatry 2006;51:480-91.

8. Parkbury House ‘Mental health and Wellbeing Clinic’ • To test feasibility of a primary Care based clinic for people on SMI register. • NSF & NICE recommend monitoring normally carried out in primary care setting. • Joint review Practice nurse and CPN (Link Worker) support from GP’s and CMHT • 2 weekly, 2 hours, 2 patients.

9. ‘Mental Health Wellbeing Clinic’ • ECG • Bloods according to local guidelines • Rating scales • Drug Attitude Inventory-30 • Liverpool University Neuroleptic Side Effect Rating Scale • Brief Psychiatric Rating Scale • Education • Signposting

10. ‘Mental Health Wellbeing Clinic’ • 54 patients identified • 51 attended • 20 Schizophrenia, 19 Bipolar,9 Depression, 1OCD, 1PD, 1 Anxiety. • 74% receiving care from CMHT • 71% concordance diagnosis • 59% concordance with medication

11. Existing Information

12. Results • 43% had at least 1 positive screen test • 16% Physical, (BMI,BP) • 14% bloods • 3%ECG • 33% Medication, (compliance, side effects) • 43% physical education (contraception, vaccination) • 7% Social education (housing, benefits, employment)

13. Conclusion • Patients with Severe Mental Illness have increased risk of physical morbidity • Joint primary and secondary care model helps information sharing and improves overall physical,social and psychiatric outcomes.