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We aimed to compare disability rates associated with physical disorders versus psychiatric disorders and to establish treatment rates of both classes of disorder in the South African population. In a nationally representative survey of 4351 adults, treatment and prevalence rates of a range of physical and psychiatric disorders, and their associated morbidity during the previous 12 months were investigated. Physical illnesses were reported in 55.2% of the sample, 60.4% of whom received treatment for their disorder. Approximately 10% of the samples show a mental illness with 6.1% having received treatment for their disorder. The prevalence of any mental illness reported was higher than that reported individually for asthma, cancer, diabetes, and peptic ulcer. Mental disorders were consistently reported to be more disabling than physical disorders and the degree of disability increased as the number of comorbid disorders increased. Depression, in particular, was rated consistently higher across all domains than all physical disorders. Despite high rates of mental disorders and associated disability in South Africa, they are less likely to be treated than physical disorders.
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PMID:Disability and treatment of psychiatric and physical disorders in South Africa. 2006 63

When managing their patients with schizophrenia, psychiatrists are increasingly concerned about physical disorders, including weight gain, obesity, metabolic abnormalities (in particular, diabetes and the metabolic syndrome), prolactin increase, sexual dysfunction and cardiovascular disease. Other common health-related problems in these patients include recreational drug use, sedation/physical inactivity, adverse drug effects and poor self-care. Each of these can have an impact on patient well-being, adherence to therapy and life expectancy. Collectively they can pose substantial barriers to optimal outcomes. However, the widespread acknowledgement of the importance of the physical health of patients with schizophrenia does not always result in consistent monitoring and management of physical health risks in the clinic. Urgent action is needed to ensure that psychiatrists prioritise physical healthcare alongside mental healthcare as a way to improve the longterm outcomes of treatment in all patients with schizophrenia.
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PMID:The need for routine physical health care in schizophrenia. 2062 Aug 84

This international meeting discussed the management of physical health in patients with schizophrenia in several countries including France, Spain, Germany, the UK and Italy. Physical health parameters, including weight, blood pressure, blood glucose, lipids and standard biochemical assessments are measured in many patients at the first hospital consultation. These reveal physical disorders such as obesity, hypertension, dyslipidaemia, the metabolic syndrome, substance abuse, cardiovascular disease, extrapyramidal symptoms, sexual dysfunction and diabetes in substantial proportions of patients. Psychiatrists consider switching antipsychotic therapy if excessive sedation, extrapyramidal symptoms, unacceptable weight gain, hyperglycaemia or dyslipidaemia occur. In general, switching is more likely to be considered for symptomatic adverse events than for laboratory abnormalities. Switching is discouraged by limited knowledge of protocols, the absence of guidelines and fears of relapse or reduced treatment adherence. The physical health of patients with schizophrenia receives much less attention in the community setting than in the hospital setting. Improved guidelines, protocols, resources and support are needed to improve the physical health of patients in the community.
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PMID:Management of physical health in patients with schizophrenia: international insights. 2062 Aug 86

Since the care of patients with multiple chronic diseases such as diabetes and depression accounts for the majority of health care costs, effective team approaches to managing such complex care in primary care are needed, particularly since psychosocial and physical disorders coexist. Uncontrolled diabetes is a leading health risk for morbidity, disability and premature mortality with between 18-31% of patients also having undiagnosed or undertreated depression. Here we describe a team driven approach that initially focused on patients with poorly controlled diabetes (A1c > 9) that took place at a family medicare office. The team included: resident and faculty physicians, a pharmacist, social worker, nurses, behavioral medicine interns, office scheduler, and an information technologist. The team developed immediate integrative care for diabetic patients during routine office visits.
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PMID:Multidisciplinary team approach to improved chronic care management for diabetic patients in an urban safety net ambulatory care clinic. 2240 7

This article reviews recent epidemiological findings on the relationship between physical and psychiatric conditions. First, physical disorders may be a risk factor of mental disorders. The WHO World Mental Health (WMH) Surveys indicated that the prevalence of most mental disorders were high among persons with a variety of physical disorders. Second, mental disorders may affect the course and prognosis of physical disorders. Several studies reported increased mortality when depression was comorbid with cancer, stroke, heart disease and diabetes. Third, social functioning was more deteriorated among those with comorbid physical and mental disorders than those with either of them. The comorbidity with mental disorders and its impact on the longevity and social life are observed for most physical disorders.
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PMID:[Epidemiology of psychiatric disorders among medically ill patients]. 2241 86

Staging models are used routinely in general medicine for potentially serious or chronic physical disorders such as diabetes, arthritis and cancers, describing the links between biomarkers, clinical phenotypes and disease extension, and promoting a personalised or stratified medicine approach to treatment planning. Clinical staging involves a detailed description of where an individual exists on a continuum of disorder progression from stage 0 (an at-risk or latency stage) through to stage IV (late or end-stage disease). The approach is popular owing to its clinical utility and is increasingly being applied in psychiatry. The concept offers an informed approach to research and the active promotion of indicated prevention and early intervention strategies. We suggest that for young persons with emerging bipolar disorder, such transdiagnostic staging models could provide a framework that better reflects the developmental psychopathology and matches the complex longitudinal inter-relationships between subsyndromal and syndromal mood, psychotic and other disorders.
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PMID:Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value. 2354 37

Political attention is being increasingly directed to mental health in Japan. Mental disorders are now the fifth priority disease after cancer, stroke, acute myocardial infarction and diabetes for national medical services since April 2013. Each prefecture has to implement strategic mental healthcare plans at the regional level. With the increase in co-morbid mental and physical illnesses, patient information should be shared between psychiatric and non-psychiatric healthcare providers, and coordination is required in the healthcare systems. A better understanding of mental health between patients and medical staffs could contribute to improved access to psychiatric services in the integrated mental health care system. Collaborative care programs focusing on depression screening and management in the Mental Health Care Project for Patients with Physical Illness have been launched among six national specialized care and research centers (cancer, cardiovascular disease, diabetes, child care, geriatric care and neurology and psychiatry) since 2012. These efforts to integrate mental health care into the general health care system would help to improve psychiatric care for elderly patients with physical illnesses.
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PMID:[Depression in older adults: the National Mental Care Project for People with Physical Illness]. 2462 14

Human beings are social species which require safe and secure social surroundings to survive. Satisfying social relationships are essential for mental and physical well beings. Impaired social relationship can lead to loneliness. Since the time of dawn, loneliness is perceived as a global human phenomenon. Loneliness can lead to various psychiatric disorders like depression, alcohol abuse, child abuse, sleep problems, personality disorders and Alzheimer's disease. It also leads to various physical disorders like diabetes, autoimmune disorders like rheumatoid arthritis, lupus and cardiovascular diseases like coronary heart disease, hypertension (HTN), obesity, physiological aging, cancer, poor hearing and poor health. Left untended, loneliness can have serious consequences for mental and physical health of people. Therefore it is important to intervene at the right time to prevent loneliness, so that physical and mental health of patients is maintained.
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PMID:Relationship between loneliness, psychiatric disorders and physical health ? A review on the psychological aspects of loneliness. 2538 7

The authors of this editorial discuss whether or not the value of exercise is being underestimated for wellness. One response to these alarming findings has been to develop or adapt illness self-management programs specifically targeting frequently co-occurring physical disorders in this population, such as diabetes, hypertension, and coronary artery disease. Preliminary evidence from controlled studies suggests promise for these approaches. Consistent across the different studies of medical comorbidity has been the finding that cardiovascular disease is the most common cause of death in persons with a serious mental illness. This has underscored the importance of routine screening for cardiovascular risk factors in this population. It has also led to an increased focus on addressing common modifiable risk factors, with particular attention to smoking cessation and weight loss programs to address obesity. Increasing activity level through regular exercise is a common ingredient of lifestyle interventions targeting weight loss. However, the benefits of exercise may not be limited to its role in weight loss programs. Furthermore, the benefits of exercise alone for weight loss may be limited, suggesting the need to consider exercise within the broader context of quality of life improvement.
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PMID:Are we underestimating the value of exercise for wellness? 2669 96

The deleterious impact of depression on quality of life as well as mortality through suicide and worsening medical comorbidity is well known. Impairment and disability associated with depression is significant and equal to that attributable to cardiovascular disease and greater than that due to other chronic physical disorders, such as hypertension, diabetes, and arthritis (Wells et al., 1989). Depression impacts not only the individual life of the patient but affects the health of society.
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PMID:From depression to disability. 2813 64


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