− People with serious mental and physical illness fall through the gaps between physical and mental health care systems

 

EPIDEMIOLOGY 

− People with Serious Mental Illness (SMI) experience much poorer health outcomes than the general population  − Life expectancy for people with SMI is 20 years less than those without

− Around 1 in 9 people aged 16-85 experience SMI and a concurrent physical condition

− Most common comorbidity was an anxiety disorder combined with a physical condition  − People with SMI have higher smoking rates

− Comorbidity increases with decreasing SrS

Comorbidity

− Is the occurrence of more then one condition at the same time

− Can Involve one or more mental health disorders or a mental disorder with a physical health disorder

− Having multiple disorders results in; Ø Increased health risks

  • Increased disability
  • Places greater demands on health resources

 

− Its not just higher rates of mental illness and physical conditions, but its also higher rates of physical conditions and mental illness- it goes both ways!

− Having a physical illness is one of the strongest risk factors for depression

 

Metabolic Syndrome

− A cluster of different clinical presentations that we typically see among people who are on particular antipsychotic medications

− A range of abnormal clinical and metabolic findings that result in an increase of: Ø NIDDM (Type II Diabetes)

  • Cardiovascular disease

− Associated with:

  • Abdominal obesity
  • High blood pressure
  • High triglyceride
  • Low HDL- cholesterol
  • Insulin resistance

− People with SMI have much higher rates of obesity

− 50% have abnormal lipid profiles

− 33% have elevated fasting blood glucose levels

Diabetes

− Type II Diabetes (NIDDM)- progressive endocrine dysfunction characterised by:

  • rlevated blood glucose levels
  • Insulin resistance
  • Beta cell dysfunction

Complications of Diabetes 

  • Microvascular Disease- retinopathy & nephropathy
  • Diabetic neuropathies
  • Coronary vascular disease
  • Stroke (CVA)
  • Peripheral vascular disease

 

Uncontrolled Diabetes can cause:

  • Blindness
  • Heart attack
  • Brain haemorrhage
  • Kidney problems
  • Amputation of lower extremities

 

 

Cardiovascular Disease

− Refers to any disease that affects the heart and blood vessels  − The major risk factors are:

  • Smoking
  • Obesity
  • Hypertension
  • rlevated blood cholesterol

 

Cancer

− Cancer rates for those with SMI and those without are the same

− People with SMI although have a 30% greater mortality rate

− People with SMI tend to present much later and often have metastases  − People with SMI are less likely to receive specialised interventions

 

Infectious Diseases

− The prevalence of HIV is higher in those with SMI

− rlevated rates of hepatitis virus infection have been reported in people with SMI

 

Respiratory Diseases

− People with SMI have higher rates of tuberculosis

− People with schizophrenia are 1.3 times the risk of acute respiratory failure  − Rates of chronic bronchitis am emphysema are higher in those with SMI

 

Oral health

− People with SMI experience higher rates of oral health problems:

  • Dental cavities
  • Periodontal disease
  • Dental trauma
  • Oral cancers

 

− Reasons for poor oral hygiene:

  • Dry mouth due to medications
  • Cant afford dental care
  • Smoking
  • Lack of care (i.e. not brushing their teeth)

 

Sleep patterns

− Sleep is necessary for memory encoding and consolidation

− rmotional memory is susceptible to sleep deprivation (SD) − SD also leads to impaired cognition and attention

What conditions might affect sleep? 

  • Insomnia- caused by mania
  • Hypersomnia (over sleeping)- caused by depression
  • Medications
  • Schizophrenia- if people are hearing voices
  • Anxiety- e.g. lying in bed overthinking/worrying
  • Paranoia- e.g. delusional thoughts, checking or watching things
  • OCD- e.g. undertake rituals to sleep
  • Internal restlessness e.g. pacing

 

 

Trauma

− Trauma Informed Care and Practice (TICP) recognises that people with SMI have been exposed to trauma

− 60-70% of people with schizophrenia have been exposed to forms of childhood abuse

 

Intellectual Disability

− A person with an intellectual disability may have problems expressing themselves

− May have problems with:

  • rxpressing their thoughts
  • Putting together sentences
  • Learning new skills
  • Doing day to day takes
  • Making decisions
  • Remembering things

− A person with an intellectual disability AND a mental illness is called: Dual Disability

 

SMI- Comorbidity Risk Factors

Antipsychotic Medication 

  • Can cause weight gain- Clozapine and Olanzapine have the highest incidence (15-20kg gains in 6 months) Increases the risk of hyperglycaemia and dyslipidaemia

 

Smoking 

  • 66% with people with SMI are smokers compared to 15% of the general population
  • People with SMI smoke more cigarettes per day
  • People with SMI inhale more deeply

 

Diet and Exercise 

  • The sedation effect of antipsychotic drugs can cause decreased motivation   Disorganisation due to SMI can lead to negative lifestyle factors such as:
    • Poor diet
    • Lack of physical activity

 

  • People with SMI have poorer diets: Ø Higher caloric intake
    • Higher in saturated fats Ø Lower in fruit and fibre
    • Lower in vegetables, legumes and diary

 

Sexual Activity 

  • People with SMI are more likely to be involved with high risk sexual behaviours such as: Ø Unprotected sexual intercourse
    • Multiple partners
    • Involvement in sex work (prostitution) and illicit drug use

 

Drugs and Alcohol 

  • People with SMI were:
    • At increased risk of consuming high levels of alcohol in the last 12 months
    • 6 times more likely to have used an illicit drug Ø 1.6 times more likely to have used cannabis

 

 

Interventions

− All interventions are based on the principles of RrCOVrRY

  • Uniqueness of the Ø Attitude and Ø Partnership and individual rights  communication
  • Real choices Ø Dignity and Ø rvaluating respect recovery

 

Metabolic Syndrome 

  • Ongoing assessment at least every 3 months o Monitoring waist circumference  o Calculating BMI  o Monitoring BP  o Monitoring fasting lipids and blood glucose  o Monitoring level of physical activity 

Respiratory 

  • Regular and ongoing respiratory assessment
  • Cessation of smoking o Motivational interviewing/counselling  o Management of withdrawal symptoms  o Nicotine replacement therapy  o rducation

 

  • Maintaining physical activity
  • Regular influenza vaccination

 

Physical Activity 

  • Motivational interviewing
  • Face to face and group-based exercise sessions
  • Structures exercise prescriptions
  • Structure the exercise to suit age and ability

 

Nutrition 

  • rducation on balanced diet
  • Suggestions for alternate dietary patterns
  • Reducing the intake of high fat and high sugar foods

 

Oral health 

  • Smoking cessation
  • Regular dental hygiene

 

Sleep 

  • Regularly assess sleep patterns
  • Assess for obstructive sleep apnoea
  • Commence a sleep diary
  • Decrease caffeine intake before bed

 

Sexual health 

  • Promote regular screening- breast, prostate, cervical and STD
  • rducation on safe sex

 

Drug and Alcohol 

  • Regularly assess for concurrent use of alcohol and drugs
  • Motivational interviewing
  • Formal rehab programs if warranted

 

Disability 

  • Advise/organise support services as needed
  • Differentiate b/w the presentation f the disability and the signs/symptoms of mental illness